Provider Demographics
NPI:1669799516
Name:STEPHENS, DANIEL HAYDEN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HAYDEN
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 CENTER BLVD APT 2213
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5884
Mailing Address - Country:US
Mailing Address - Phone:310-770-4311
Mailing Address - Fax:
Practice Address - Street 1:4610 CENTER BLVD APT 2213
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11109-5884
Practice Address - Country:US
Practice Address - Phone:310-770-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271996208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics