Healthcare Provider Details

I. General information

NPI: 1013904465
Provider Name (Legal Business Name): JENNIFER ANN TAY M.C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PCS 41 BOX 482
APO AA
09464-9998
US

IV. Provider business mailing address

PCS 41 BOX 482
APO AA
09464-9998
US

V. Phone/Fax

Practice location:
  • Phone: 163-853-3308
  • Fax:
Mailing address:
  • Phone: 163-853-3308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51380
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: