Healthcare Provider Details

I. General information

NPI: 1164982021
Provider Name (Legal Business Name): NICOLE HAYS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 DRIGGS AVE FL 2
BROOKLYN NY
11211-3230
US

IV. Provider business mailing address

606 DRIGGS AVE APT 2
BROOKLYN NY
11211-3230
US

V. Phone/Fax

Practice location:
  • Phone: 520-465-2001
  • Fax: 520-317-1033
Mailing address:
  • Phone: 646-389-4218
  • Fax: 520-317-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number320469
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MB13134700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: