Healthcare Provider Details

I. General information

NPI: 1770819815
Provider Name (Legal Business Name): CHRISTINE B. BAILEY, PH.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2009
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MAGNOLIA ST
NEW SMYRNA BEACH FL
32168-7144
US

IV. Provider business mailing address

305 MAGNOLIA ST
NEW SMYRNA BEACH FL
32168-7144
US

V. Phone/Fax

Practice location:
  • Phone: 386-732-7861
  • Fax:
Mailing address:
  • Phone: 386-732-7861
  • Fax: 386-310-0571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1402
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE B BAILEY
Title or Position: NEUROPSYCHOLOGIST
Credential: PHD
Phone: 386-732-7861