MEDICARE: TANYA BAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	022125-1	NY

General Provider Information

NPI Number	:	1053630608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA BAKER

Provider Business Mailing Address
First Line	:	9159 MAIN ST
Second Line	:
City	:	CLARENCE
State	:	NY
Zip	:	14031-1931
Country	:	US
Telephone Number	:	716-995-7455
Fax Number	:

Provider Business Practice Location Address
First Line	:	9159 MAIN ST
Second Line	:
City	:	CLARENCE
State	:	NY
Zip	:	14031-1931
Country	:	US
Telephone Number	:	716-995-7455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	05/21/2010

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Directions to “ TANYA BAKER ” Practice Location

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