Provider Demographics
NPI:1801396270
Name:CHIZUK, HALEY (PHD, ATC)
Entity type:Individual
Prefix:DR
First Name:HALEY
Middle Name:
Last Name:CHIZUK
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 OLD LAKE SHORE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9522
Mailing Address - Country:US
Mailing Address - Phone:716-432-0533
Mailing Address - Fax:
Practice Address - Street 1:111 N MAPLEMERE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-3181
Practice Address - Country:US
Practice Address - Phone:716-204-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2024-08-07
Deactivation Date:2019-05-22
Deactivation Code:
Reactivation Date:2023-12-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer