Healthcare Provider Details

I. General information

NPI: 1073439865
Provider Name (Legal Business Name): DANIELLE LAUREN HAYNES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 LAKE AVE
BLASDELL NY
14219-1216
US

IV. Provider business mailing address

155 LAWN AVE
BUFFALO NY
14207-1816
US

V. Phone/Fax

Practice location:
  • Phone: 716-332-3070
  • Fax:
Mailing address:
  • Phone: 716-875-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: