Provider Demographics
NPI:1326469420
Name:ZASADA, AUDRA LYNN
Entity Type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:LYNN
Last Name:ZASADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:LYNN
Other - Last Name:WAIDELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8205 MAIN STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-626-2222
Mailing Address - Fax:716-626-2220
Practice Address - Street 1:8205 MAIN STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-626-2222
Practice Address - Fax:716-626-2220
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator