Provider Demographics
NPI:1114323888
Name:BAYLIS, CHERYL (MA, ITDS)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BAYLIS
Suffix:
Gender:F
Credentials:MA, ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37328 N COUNTY ROAD 44A
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-9753
Mailing Address - Country:US
Mailing Address - Phone:352-267-1101
Mailing Address - Fax:
Practice Address - Street 1:37328 N COUNTY ROAD 44A
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32736
Practice Address - Country:US
Practice Address - Phone:352-267-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency