Provider Demographics
NPI:1225527922
Name:TEODORO, NICHOLAS STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:STEPHEN
Last Name:TEODORO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:101 NICOLLS RD # HSC8
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 SMITH HAVEN MALL STE 1
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1219
Practice Address - Country:US
Practice Address - Phone:631-444-4686
Practice Address - Fax:631-444-4622
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2025-08-12
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Provider Licenses
StateLicense IDTaxonomies
NY318989207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology