Healthcare Provider Details

I. General information

NPI: 1437629722
Provider Name (Legal Business Name): BEATRICE AYANNA HUTCHERSON MS.SPED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MCKENZIE CT
MIDDLETOWN NY
10940-5069
US

IV. Provider business mailing address

75 CRYSTAL RUN RD STE 201
MIDDLETOWN NY
10941-7010
US

V. Phone/Fax

Practice location:
  • Phone: 718-801-6267
  • Fax:
Mailing address:
  • Phone: 845-692-4391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1329059
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: