Healthcare Provider Details

I. General information

NPI: 1871889303
Provider Name (Legal Business Name): TASSY N. HAYDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 HAMPTON AVE
SAINT LOUIS MO
63139-2935
US

IV. Provider business mailing address

2340 HAMPTON AVE
SAINT LOUIS MO
63139-2935
US

V. Phone/Fax

Practice location:
  • Phone: 314-647-2200
  • Fax: 314-647-4172
Mailing address:
  • Phone: 314-647-2200
  • Fax: 314-647-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number248385
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014021718
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: