Provider Demographics
NPI:1487039616
Name:BYAS, RITA
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:
Last Name:BYAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 KINGSHWY APT 4H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2913
Mailing Address - Country:US
Mailing Address - Phone:347-836-3798
Mailing Address - Fax:
Practice Address - Street 1:3900 KINGS HWY APT 4H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2913
Practice Address - Country:US
Practice Address - Phone:347-836-3798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275305-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse