Provider Demographics
NPI:1801144365
Name:WAYNES, EUNICE RACHEL (TEACHER)
Entity type:Individual
Prefix:MRS
First Name:EUNICE
Middle Name:RACHEL
Last Name:WAYNES
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1634
Mailing Address - Country:US
Mailing Address - Phone:516-285-0411
Mailing Address - Fax:718-446-3444
Practice Address - Street 1:41 IRVING ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1634
Practice Address - Country:US
Practice Address - Phone:516-285-0411
Practice Address - Fax:718-446-3444
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist