Provider Demographics
NPI:1790020899
Name:DELAHAYE, TRACEY ANTOINETTE
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:ANTOINETTE
Last Name:DELAHAYE
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 1:1244 RYDER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2817
Mailing Address - Country:US
Mailing Address - Phone:347-463-0499
Mailing Address - Fax:
Practice Address - Street 1:1244 RYDER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2817
Practice Address - Country:US
Practice Address - Phone:347-463-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY827233174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist