Healthcare Provider Details

I. General information

NPI: 1306762554
Provider Name (Legal Business Name): HAILEY DWYER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MOISEY DR STE 202
HAZLE TOWNSHIP PA
18202-9297
US

IV. Provider business mailing address

1117 CINNAMINSON AVE
CINNAMINSON NJ
08077-2102
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-5030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA007764
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: