Provider Demographics
NPI:1750167045
Name:DAYES, LATASHA
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:DAYES
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 1:18722 KEESEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2332
Mailing Address - Country:US
Mailing Address - Phone:631-530-6099
Mailing Address - Fax:
Practice Address - Street 1:10919 FARMERS BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-1064
Practice Address - Country:US
Practice Address - Phone:866-626-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAEC-20-03865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist