Healthcare Provider Details

I. General information

NPI: 1750150934
Provider Name (Legal Business Name): MISS NADIIRA A HAYBE JR.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 DELAWARE AVE
BUFFALO NY
14209-2006
US

IV. Provider business mailing address

768 DELAWARE AVE
BUFFALO NY
14209-2006
US

V. Phone/Fax

Practice location:
  • Phone: 716-856-2587
  • Fax: 716-886-4002
Mailing address:
  • Phone: 716-856-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: