Healthcare Provider Details

I. General information

NPI: 1770120602
Provider Name (Legal Business Name): HAYLEY SARA FLYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 W 78TH ST APT 11C
NEW YORK NY
10024-6708
US

IV. Provider business mailing address

110 W 86TH ST APT 8D
NEW YORK NY
10024-4060
US

V. Phone/Fax

Practice location:
  • Phone: 845-558-1945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number002285
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: