Provider Demographics
NPI:1700601598
Name:HAYNES-WILLISTON, DARNETH NADEEN (PTA)
Entity type:Individual
Prefix:MRS
First Name:DARNETH
Middle Name:NADEEN
Last Name:HAYNES-WILLISTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13735 218TH ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2240
Mailing Address - Country:US
Mailing Address - Phone:646-303-1594
Mailing Address - Fax:
Practice Address - Street 1:13735 218TH ST
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2240
Practice Address - Country:US
Practice Address - Phone:646-303-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY66007319208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation