Provider Demographics
NPI:1417418963
Name:SCHLUSSELBERG, BAILA (MS, WHNP, IBCLC, MNN)
Entity Type:Individual
Prefix:
First Name:BAILA
Middle Name:
Last Name:SCHLUSSELBERG
Suffix:
Gender:F
Credentials:MS, WHNP, IBCLC, MNN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 DERBY AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2820
Mailing Address - Country:US
Mailing Address - Phone:347-633-4358
Mailing Address - Fax:
Practice Address - Street 1:320 DERBY AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2820
Practice Address - Country:US
Practice Address - Phone:347-633-4358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY659403163WL0100X
NY421671363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant