MEDICARE: TIFFANY BUENO CLC

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	174N00000X	Lactation Consultant (Non-RN)	ALPP-312628	NY
2	374J00000X	Doula		NY

General Provider Information

NPI Number	:	1053884759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY BUENO CLC

Provider Business Mailing Address
First Line	:	310 S 3RD ST APT 25
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-4643
Country	:	US
Telephone Number	:	347-605-0447
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 S 3RD ST APT 25
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-4643
Country	:	US
Telephone Number	:	347-605-0447
Fax Number	:

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

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	01/04/2019

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