Healthcare Provider Details

I. General information

NPI: 1538917687
Provider Name (Legal Business Name): AMBER LEE HAYNES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CORNELL DR
CANTON NY
13617-1098
US

IV. Provider business mailing address

34 CORNELL DR
CANTON NY
13617-1037
US

V. Phone/Fax

Practice location:
  • Phone: 315-386-7333
  • Fax: 315-386-7932
Mailing address:
  • Phone: 315-386-7333
  • Fax: 315-386-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354251
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number711717
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: