Provider Demographics
NPI:1114170750
Name:YURECHKO, ANDREW JOHN
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JOHN
Last Name:YURECHKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8603 SW 49TH CIR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6150
Mailing Address - Country:US
Mailing Address - Phone:585-694-6578
Mailing Address - Fax:
Practice Address - Street 1:8603 SW 49TH CIR
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6150
Practice Address - Country:US
Practice Address - Phone:706-446-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1034476133V00000X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist