Provider Demographics
NPI:1396032207
Name:WATTS, RAKIYA (CNM)
Entity Type:Individual
Prefix:
First Name:RAKIYA
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:CNM
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-3987
Mailing Address - Fax:631-444-8954
Practice Address - Street 1:UNIVERSITY ASSOCIATES IN OB GYN
Practice Address - Street 2:STONY BROOK UNIVERSITY HOSPITAL, HSC LEVEL 9, ROOM 090
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8091
Practice Address - Country:US
Practice Address - Phone:631-444-3987
Practice Address - Fax:631-444-8954
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF001433367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife