Provider Demographics
NPI:1083827208
Name:HAYES, MARYANN O'MELIA (LDN)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:O'MELIA
Last Name:HAYES
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 MAIN ST
Mailing Address - Street 2:3RD FLOOR DIABETES EDUC AND SELF MGMT PROGRAM
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1000
Mailing Address - Country:US
Mailing Address - Phone:413-794-7194
Mailing Address - Fax:413-794-7133
Practice Address - Street 1:3300 MAIN ST
Practice Address - Street 2:3RD FLOOR DIABETES EDUC AND SELF MGMT PROGRAM
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-1001
Practice Address - Country:US
Practice Address - Phone:413-794-7194
Practice Address - Fax:413-794-7133
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1427133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist