Provider Demographics
NPI:1528369113
Name:PARDEE, ASHLYN (LAC)
Entity Type:Individual
Prefix:MS
First Name:ASHLYN
Middle Name:
Last Name:PARDEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LIVINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1942
Mailing Address - Country:US
Mailing Address - Phone:716-440-8018
Mailing Address - Fax:
Practice Address - Street 1:1109 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1601
Practice Address - Country:US
Practice Address - Phone:716-440-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004484-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY128296OtherNCCAOM NATIONAL BOARD CERTIFICATION