Provider Demographics
NPI:1316592710
Name:ALBERTUS, HAYDEN DOUGHERTY (AUD)
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:DOUGHERTY
Last Name:ALBERTUS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:HAYDEN
Other - Middle Name:
Other - Last Name:DOUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:875 OLD COUNTRY RD FL 2
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4942
Mailing Address - Country:US
Mailing Address - Phone:516-931-5552
Mailing Address - Fax:
Practice Address - Street 1:875 OLD COUNTRY RD FL 2
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4942
Practice Address - Country:US
Practice Address - Phone:516-931-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-03
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.02194231H00000X
NY003245231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist