Provider Demographics
NPI:1932863859
Name:BAYNE, TINA T
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:T
Last Name:BAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:T
Other - Last Name:BAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:366 NORFELD BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3641
Mailing Address - Country:US
Mailing Address - Phone:917-993-0801
Mailing Address - Fax:
Practice Address - Street 1:366 NORFELD BLVD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3641
Practice Address - Country:US
Practice Address - Phone:917-993-0801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1075309252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency