Provider Demographics
NPI:1053884759
Name:BUENO, TIFFANY (CLC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BUENO
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S 3RD ST APT 25
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4643
Mailing Address - Country:US
Mailing Address - Phone:347-605-0447
Mailing Address - Fax:
Practice Address - Street 1:310 S 3RD ST APT 25
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-4643
Practice Address - Country:US
Practice Address - Phone:347-605-0447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYALPP-312628174N00000X
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN