MEDICARE: MISS MICHELLE HAYES PA-C

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	363A00000X	Physician Assistant	MA058813	PA
2	363A00000X	Physician Assistant	OA004038	PA

General Provider Information

NPI Number	:	1356886519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELLE HAYES PA-C

Provider Business Mailing Address
First Line	:	4529 MARPLE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3715
Country	:	US
Telephone Number	:	215-834-5865
Fax Number	:

Provider Business Practice Location Address
First Line	:	4529 MARPLE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3715
Country	:	US
Telephone Number	:	215-834-5865
Fax Number	:

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

Provider Enumeration Date	:	12/27/2016
Last Update Date	:	12/27/2016

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