Healthcare Provider Details

I. General information

NPI: 1346017761
Provider Name (Legal Business Name): IYANA IMIRII HEYWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 N I10 SERVICE ROAD
METARIE LA
70006
US

IV. Provider business mailing address

350 FAIRWAY DR STE 101
DEERFIELD BCH FL
33441-1834
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-9270
  • Fax:
Mailing address:
  • Phone: 877-418-2978
  • Fax: 866-500-2978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number060415104
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: