Provider Demographics
NPI:1639882426
Name:RAINEY-HAYNES, EBONI SHAVONE
Entity Type:Individual
Prefix:DR
First Name:EBONI
Middle Name:SHAVONE
Last Name:RAINEY-HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EBONI
Other - Middle Name:S
Other - Last Name:RAINEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR
Mailing Address - Street 1:851 W STATE ROAD 436 STE 1005
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3055
Mailing Address - Country:US
Mailing Address - Phone:407-383-0643
Mailing Address - Fax:407-266-0977
Practice Address - Street 1:851 W STATE ROAD 436 STE 1005
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3055
Practice Address - Country:US
Practice Address - Phone:407-383-0643
Practice Address - Fax:407-266-0977
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFB9767225174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist