Provider Demographics
NPI:1306004163
Name:BAER-SHALEV, TARYN (MD MPH)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:BAER-SHALEV
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 IRVING PKWY
Mailing Address - Street 2:STE 130
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-5301
Mailing Address - Country:US
Mailing Address - Phone:203-371-7111
Mailing Address - Fax:203-332-0376
Practice Address - Street 1:401 IRVING PKWY STE 230
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-5301
Practice Address - Country:US
Practice Address - Phone:919-385-8850
Practice Address - Fax:919-385-8850
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233488208000000X
CT049604208000000X
NC2020-03124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1225073554Medicaid
CT004234788Medicaid