Healthcare Provider Details

I. General information

NPI: 1629144753
Provider Name (Legal Business Name): PAULINE GLORIA BAILEY MA FAAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 NEWFIELD DRIVE
STAMFORD CT
06905
US

IV. Provider business mailing address

104 NEWFIELD DRIVE
STAMFORD CT
06905
US

V. Phone/Fax

Practice location:
  • Phone: 203-322-2942
  • Fax: 203-329-2449
Mailing address:
  • Phone: 203-322-2942
  • Fax: 203-329-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000047
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number00047
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number000047
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number000047
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: