Provider Demographics
NPI:1992517346
Name:GAILLOT, TIFFANY VICTORIA
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:VICTORIA
Last Name:GAILLOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 24TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4415
Mailing Address - Country:US
Mailing Address - Phone:929-789-4380
Mailing Address - Fax:
Practice Address - Street 1:3536 24TH ST APT 2C
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4415
Practice Address - Country:US
Practice Address - Phone:929-789-4380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency