Healthcare Provider Details

I. General information

NPI: 1114861184
Provider Name (Legal Business Name): ALAYDI RACHID BARRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

1 BAY CLUB DR BAY BAYSIDE
BAYSIDE NY
11360-2955
US

V. Phone/Fax

Practice location:
  • Phone: 551-339-5163
  • Fax:
Mailing address:
  • Phone: 551-339-5163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number13-3971298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: