Healthcare Provider Details

I. General information

NPI: 1972244903
Provider Name (Legal Business Name): MR. ANDREW JOHN HAYNES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10016 PRATT RD
DELEVAN NY
14042-9428
US

IV. Provider business mailing address

10016 PRATT RD
DELEVAN NY
14042-9428
US

V. Phone/Fax

Practice location:
  • Phone: 716-258-9087
  • Fax:
Mailing address:
  • Phone: 716-258-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number516223
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: