Provider Demographics
NPI:1487178695
Name:BAYLY, STEPHANIE BRYNN
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BRYNN
Last Name:BAYLY
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 1:16045 OLD ASH LOOP
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6901
Mailing Address - Country:US
Mailing Address - Phone:321-987-1617
Mailing Address - Fax:
Practice Address - Street 1:16045 OLD ASH LOOP
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6901
Practice Address - Country:US
Practice Address - Phone:321-987-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator