Healthcare Provider Details

I. General information

NPI: 1891283701
Provider Name (Legal Business Name): KENYETTA W HAYES MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 RIVER ST
MILFORD CT
06460-3315
US

IV. Provider business mailing address

98 COURTLAND CIR UNIT 2
STAMFORD CT
06902-4303
US

V. Phone/Fax

Practice location:
  • Phone: 203-818-8659
  • Fax:
Mailing address:
  • Phone: 203-818-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: