Basic Information
| Provider Information | |||||||||
| NPI: | 1306004163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAER-SHALEV | ||||||||
| FirstName: | TARYN | ||||||||
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| Credential: | MD MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 IRVING PKWY | ||||||||
| Address2: | STE 130 | ||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275405301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033717111 | ||||||||
| FaxNumber: | 2033320376 | ||||||||
| Practice Location | |||||||||
| Address1: | 3180 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066064237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033717111 | ||||||||
| FaxNumber: | 2033320376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 233488 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 2020-03124 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 049604 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 004234788 | 05 | CT | MEDICAID |