Healthcare Provider Details

I. General information

NPI: 1376437350
Provider Name (Legal Business Name): ANDRIY GAYDAYCHUK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 FIRST COLONIAL RD STE 104
VIRGINIA BEACH VA
23451-6119
US

IV. Provider business mailing address

1441 LASKIN RD APT 234
VIRGINIA BEACH VA
23451-6174
US

V. Phone/Fax

Practice location:
  • Phone: 757-648-7472
  • Fax:
Mailing address:
  • Phone: 631-506-6282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420160
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: