Healthcare Provider Details

I. General information

NPI: 1235033002
Provider Name (Legal Business Name): CAROLEE WACHOB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14016 ROUTE 31
ALBION NY
14411-9382
US

IV. Provider business mailing address

11732 LAKESHORE RD
LYNDONVILLE NY
14098-9304
US

V. Phone/Fax

Practice location:
  • Phone: 585-589-3267
  • Fax:
Mailing address:
  • Phone: 585-589-3267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: