Healthcare Provider Details

I. General information

NPI: 1861339764
Provider Name (Legal Business Name): AYNIA HASAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 CROSSPOINT BLVD STE 250
INDIANAPOLIS IN
46256-3387
US

IV. Provider business mailing address

10475 CROSSPOINT BLVD STE 250
INDIANAPOLIS IN
46256-3387
US

V. Phone/Fax

Practice location:
  • Phone: 462-205-0087
  • Fax: 462-205-0087
Mailing address:
  • Phone: 462-205-0087
  • Fax: 462-205-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: