Healthcare Provider Details

I. General information

NPI: 1205416336
Provider Name (Legal Business Name): HAYA RAEF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 PEACHTREE ST NW UNIT 1407
ATLANTA GA
30309-8402
US

IV. Provider business mailing address

145 HARRISON AVE
BOSTON MA
02111-1802
US

V. Phone/Fax

Practice location:
  • Phone: 207-766-1408
  • Fax:
Mailing address:
  • Phone: 207-766-1408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number114480
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: