Provider Demographics
NPI:1699181693
Name:WALCZYK, RACHEL (PA)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:WALCZYK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:KIRSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:449 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SALAMANCA
Mailing Address - State:NY
Mailing Address - Zip Code:14779-1455
Mailing Address - Country:US
Mailing Address - Phone:716-945-4770
Mailing Address - Fax:716-945-2393
Practice Address - Street 1:449 BROAD ST
Practice Address - Street 2:
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-1455
Practice Address - Country:US
Practice Address - Phone:716-945-4770
Practice Address - Fax:716-945-2393
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017604363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant