Provider Demographics
NPI:1629144753
Name:BAILEY, PAULINE GLORIA (MA FAAA)
Entity Type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:GLORIA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MA FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 NEWFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905
Mailing Address - Country:US
Mailing Address - Phone:203-322-2942
Mailing Address - Fax:203-329-2449
Practice Address - Street 1:104 NEWFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905
Practice Address - Country:US
Practice Address - Phone:203-322-2942
Practice Address - Fax:203-329-2449
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000047231H00000X, 231HA2500X, 231HA2400X
CT00047237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004050183OtherDME
CT004050175Medicaid
CT004050175Medicaid
CTC01673Medicare PIN