Provider Demographics
NPI:1932387412
Name:HYATT, BEVERLY MCCDONALD
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:MCCDONALD
Last Name:HYATT
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 1:32 HAMPTON HILL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5840
Mailing Address - Country:US
Mailing Address - Phone:716-633-6133
Mailing Address - Fax:716-632-2253
Practice Address - Street 1:32 HAMPTON HILL DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5840
Practice Address - Country:US
Practice Address - Phone:716-633-6133
Practice Address - Fax:716-632-2253
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238860-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02744241Medicaid