Healthcare Provider Details

I. General information

NPI: 1043265291
Provider Name (Legal Business Name): VICKI HAWRYLAK DE CARRASCO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 LIBERTY AVENUE SUITE 310
PITTSBURGH PA
15224-2156
US

IV. Provider business mailing address

4815 LIBERTY AVENUE SUITE 310
PITTSBURGH PA
15224-2156
US

V. Phone/Fax

Practice location:
  • Phone: 412-578-1116
  • Fax: 412-605-6396
Mailing address:
  • Phone: 412-578-1116
  • Fax: 412-605-6396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA001983L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA001983L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: