Provider Demographics
NPI:1689836264
Name:HAYES MAXWELL, CIANA TYIESH (MD)
Entity Type:Individual
Prefix:DR
First Name:CIANA
Middle Name:TYIESH
Last Name:HAYES MAXWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CIANA
Other - Middle Name:T
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2142 HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NJ
Mailing Address - Zip Code:08065-1121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5045 ROUTE 130 STE F
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-9707
Practice Address - Country:US
Practice Address - Phone:856-461-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT193245208000000X
NJ25MA08975900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics