Provider Demographics
NPI:1235221557
Name:ODACHOWSKI, ALLYSON ERICA (RDN, CDN)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:ERICA
Last Name:ODACHOWSKI
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4578 S AYERS RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-9509
Mailing Address - Country:US
Mailing Address - Phone:716-553-1554
Mailing Address - Fax:
Practice Address - Street 1:2801 WEHRLE DR STE 4
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7381
Practice Address - Country:US
Practice Address - Phone:716-626-7415
Practice Address - Fax:716-632-0389
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
NY005917-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA8175Medicare PIN
NYBA0664Medicare PIN