Provider Demographics
NPI:1063575819
Name:BRAELL, TERESA ELIZABETH (RN)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ELIZABETH
Last Name:BRAELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:ELIZABETH
Other - Last Name:SHETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:34 JACARANDA COURT
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2610
Mailing Address - Country:US
Mailing Address - Phone:585-377-4497
Mailing Address - Fax:
Practice Address - Street 1:811 CHEESE FACTORY ROAD
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-9208
Practice Address - Country:US
Practice Address - Phone:585-582-1741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3069741163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02063734Medicaid