Healthcare Provider Details

I. General information

NPI: 1154283018
Provider Name (Legal Business Name): KERRY-ANN NICOLE BAILEY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LINWOOD ST
BROOKLYN NY
11208-2116
US

IV. Provider business mailing address

3614 165TH ST APT 6HS
FLUSHING NY
11358-2040
US

V. Phone/Fax

Practice location:
  • Phone: 516-360-6538
  • Fax:
Mailing address:
  • Phone: 516-360-6538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number034437
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: