Provider Demographics
NPI:1891283701
Name:HAYES, KENYETTA W (MT)
Entity Type:Individual
Prefix:MS
First Name:KENYETTA
Middle Name:W
Last Name:HAYES
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 COURTLAND CIR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4303
Mailing Address - Country:US
Mailing Address - Phone:203-818-8659
Mailing Address - Fax:
Practice Address - Street 1:51 RIVER ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3315
Practice Address - Country:US
Practice Address - Phone:203-818-8659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
009668OtherCONNECTICUT STATE LIC