Provider Demographics
NPI:1972244903
Name:HAYNES, ANDREW JOHN
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JOHN
Last Name:HAYNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10016 PRATT RD
Mailing Address - Street 2:
Mailing Address - City:DELEVAN
Mailing Address - State:NY
Mailing Address - Zip Code:14042-9428
Mailing Address - Country:US
Mailing Address - Phone:716-258-9087
Mailing Address - Fax:
Practice Address - Street 1:10016 PRATT RD
Practice Address - Street 2:
Practice Address - City:DELEVAN
Practice Address - State:NY
Practice Address - Zip Code:14042-9428
Practice Address - Country:US
Practice Address - Phone:716-258-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY516223163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty