Provider Demographics
NPI:1699823039
Name:HAYLES, DIANA FLORENCE (EDD, MED, ITDS,)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:FLORENCE
Last Name:HAYLES
Suffix:
Gender:F
Credentials:EDD, MED, ITDS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 MACKEREL DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-8472
Mailing Address - Country:US
Mailing Address - Phone:863-386-5451
Mailing Address - Fax:
Practice Address - Street 1:4416 MACKEREL DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-8472
Practice Address - Country:US
Practice Address - Phone:863-386-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004719600Medicaid
FL811569900Medicaid