Basic Information
| Provider Information | |||||||||
| NPI: | 1932394483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRATTARELLI | ||||||||
| FirstName: | TEASHA-LEE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 733784 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753733784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828851396 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 W LANCASTER AVE | ||||||||
| Address2: | 205 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761023410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173368611 | ||||||||
| FaxNumber: | 8173902981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2007 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0006X | P4569 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Developmental – Behavioral Pediatrics | 208000000X | 34. 009726 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.