MEDICARE: MRS. ALLYSON ERICA ODACHOWSKI RDN, CDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist
2	133V00000X	Registered Dietitian	005917-1	NY

General Provider Information

NPI Number	:	1235221557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLYSON ERICA ODACHOWSKI RDN, CDN

Provider Business Mailing Address
First Line	:	4578 S AYERS RD
Second Line	:
City	:	AKRON
State	:	NY
Zip	:	14001-9509
Country	:	US
Telephone Number	:	716-553-1554
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 WEHRLE DR STE 4
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-7381
Country	:	US
Telephone Number	:	716-626-7415
Fax Number	:	716-632-0389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	05/02/2023

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