MEDICARE: ISYLAH I HAYNES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula		TX

General Provider Information

NPI Number	:	1104695535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISYLAH I HAYNES

Provider Business Mailing Address
First Line	:	68 RADCLIFFE ST
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02121-2118
Country	:	US
Telephone Number	:	857-243-1630
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 RADCLIFFE ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02121-2118
Country	:	US
Telephone Number	:	857-243-1630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	12/27/2023

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Directions to “ ISYLAH I HAYNES ” Practice Location

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