Healthcare Provider Details

I. General information

NPI: 1639091390
Provider Name (Legal Business Name): THERESA ANNE HAYDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EAGLE ST APT 1602
BROOKLYN NY
11222-7752
US

IV. Provider business mailing address

29 OAK LN
WAYNE NJ
07470-3426
US

V. Phone/Fax

Practice location:
  • Phone: 973-980-1296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: