Provider Demographics
NPI:1740960483
Name:HYMAN, AUDREY MAVANIE
Entity type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:MAVANIE
Last Name:HYMAN
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 1:2567 BEDFORD AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7075
Mailing Address - Country:US
Mailing Address - Phone:347-224-1894
Mailing Address - Fax:
Practice Address - Street 1:2567 BEDFORD AVE APT 3F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7075
Practice Address - Country:US
Practice Address - Phone:347-224-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC774171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator