Provider Demographics
NPI:1164915153
Name:BAEZ, BRIANA ANGELINE
Entity Type:Individual
Prefix:MISS
First Name:BRIANA
Middle Name:ANGELINE
Last Name:BAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3036 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5733
Mailing Address - Country:US
Mailing Address - Phone:718-823-3190
Mailing Address - Fax:718-676-7715
Practice Address - Street 1:1277 HOE AVE # PH
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-1693
Practice Address - Country:US
Practice Address - Phone:718-801-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY031415-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist