Provider Demographics
NPI:1356329510
Name:BALLARD, TAKIYA SAKINA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:TAKIYA
Middle Name:SAKINA
Last Name:BALLARD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CATHEDRAL AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-2026
Mailing Address - Country:US
Mailing Address - Phone:347-265-2632
Mailing Address - Fax:347-289-5451
Practice Address - Street 1:68 3RD ST STE 246
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231
Practice Address - Country:US
Practice Address - Phone:347-289-5451
Practice Address - Fax:347-289-5451
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00064200367A00000X
NYF001549-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife