Provider Demographics
NPI:1417657560
Name:KACHAYLO, ERICA MARIE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:KACHAYLO
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 1:28 WINTERBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1243
Mailing Address - Country:US
Mailing Address - Phone:585-794-9724
Mailing Address - Fax:
Practice Address - Street 1:28 WINTERBERRY CIR
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1243
Practice Address - Country:US
Practice Address - Phone:585-794-9724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program