Provider Demographics
NPI:1134373335
Name:KACHERSKI, DEBORAH ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:KACHERSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 HALLOCK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1244
Mailing Address - Country:US
Mailing Address - Phone:631-928-9355
Mailing Address - Fax:631-928-9351
Practice Address - Street 1:815 HALLOCK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1244
Practice Address - Country:US
Practice Address - Phone:631-928-9355
Practice Address - Fax:631-928-9351
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily