Provider Demographics
NPI:1336288604
Name:BELIN, GAYLE
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:
Last Name:BELIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:
Other - Last Name:BELIN FROST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1834 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5101
Mailing Address - Country:US
Mailing Address - Phone:802-373-3918
Mailing Address - Fax:
Practice Address - Street 1:1834 MASON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5101
Practice Address - Country:US
Practice Address - Phone:802-373-3918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00582536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
66V021OtherMVP
28347OtherBLUE CROSS BLUE SHIELD