Healthcare Provider Details

I. General information

NPI: 1346940152
Provider Name (Legal Business Name): ALIESHA LAVRINCIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 HERKIMER RD
DARIEN CENTER NY
14040-9750
US

IV. Provider business mailing address

1326 HERKIMER RD
DARIEN CENTER NY
14040-9750
US

V. Phone/Fax

Practice location:
  • Phone: 585-813-8970
  • Fax:
Mailing address:
  • Phone: 585-813-8970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number809757
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: