Provider Demographics
NPI:1891454245
Name:BAYDA, YEVGENIYA
Entity Type:Individual
Prefix:
First Name:YEVGENIYA
Middle Name:
Last Name:BAYDA
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 1:1529 PENSTOCK LN
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4923
Mailing Address - Country:US
Mailing Address - Phone:919-324-5379
Mailing Address - Fax:
Practice Address - Street 1:1529 PENSTOCK LN
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4923
Practice Address - Country:US
Practice Address - Phone:919-324-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty