Healthcare Provider Details

I. General information

NPI: 1861603078
Provider Name (Legal Business Name): ANDREA RENEE BAILEY MA, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 WAKE FOREST RD
RALEIGH NC
27609-7376
US

IV. Provider business mailing address

3480 WAKE FOREST RD
RALEIGH NC
27609-7376
US

V. Phone/Fax

Practice location:
  • Phone: 919-862-5741
  • Fax:
Mailing address:
  • Phone: 919-862-5741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2825
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2825
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: