Healthcare Provider Details

I. General information

NPI: 1710716709
Provider Name (Legal Business Name): FAITH MARIE HALEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 DEGRANDPRE WAY STE 100
PLATTSBURGH NY
12901-6452
US

IV. Provider business mailing address

16 DEGRANDPRE WAY STE 100
PLATTSBURGH NY
12901-6452
US

V. Phone/Fax

Practice location:
  • Phone: 518-306-7255
  • Fax:
Mailing address:
  • Phone: 518-306-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number033680
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: