Healthcare Provider Details

I. General information

NPI: 1801778188
Provider Name (Legal Business Name): ELLYN HAYES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN STREET WENDE HALL
BUFFALO NY
14214
US

IV. Provider business mailing address

3435 MAIN STREET WENDE HALL
BUFFALO NY
14214
US

V. Phone/Fax

Practice location:
  • Phone: 716-984-8169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number687518
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: