Provider Demographics
NPI:1255327250
Name:MULLINGS, JOAN HAINES (AUD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:HAINES
Last Name:MULLINGS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 SHAGBARK WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8951
Mailing Address - Country:US
Mailing Address - Phone:585-704-3554
Mailing Address - Fax:
Practice Address - Street 1:2596 BAIRD RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2333
Practice Address - Country:US
Practice Address - Phone:585-419-8173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-25
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY739231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS23624Medicare UPIN
NYIA0595Medicare PIN
NY200000739OtherBLUE CROSS/BLUE SHIELD
NY02581937Medicaid
NYIA0595Medicare PIN