Provider Demographics
NPI:1588356422
Name:HAYNES, AHAMAD EMMANUEL (,NP)
Entity type:Individual
Prefix:MR
First Name:AHAMAD
Middle Name:EMMANUEL
Last Name:HAYNES
Suffix:
Gender:M
Credentials:,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 WILLMOHR ST APT 3J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-2602
Mailing Address - Country:US
Mailing Address - Phone:929-444-3289
Mailing Address - Fax:
Practice Address - Street 1:994 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:929-444-3289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF311179-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health