Provider Demographics
NPI:1356684815
Name:PENNY, HAYWARD S (MS, RDN)
Entity Type:Individual
Prefix:MR
First Name:HAYWARD
Middle Name:S
Last Name:PENNY
Suffix:
Gender:M
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20501 LIVERNOIS AVE.
Mailing Address - Street 2:P.O. BOX 21937
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-9998
Mailing Address - Country:US
Mailing Address - Phone:313-864-0300
Mailing Address - Fax:
Practice Address - Street 1:58 PARSONS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-864-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered