Provider Demographics
NPI:1710431010
Name:RAY, TAFFIE (LPN)
Entity Type:Individual
Prefix:
First Name:TAFFIE
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TAFFIE
Other - Middle Name:
Other - Last Name:MADISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:375 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4022
Mailing Address - Country:US
Mailing Address - Phone:631-294-2517
Mailing Address - Fax:
Practice Address - Street 1:375 BAY AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4022
Practice Address - Country:US
Practice Address - Phone:631-294-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322499-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse