Provider Demographics
NPI:1194861187
Name:RUDNICKI, TRACY LYNN (LAC, MS, NCCAOM)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LYNN
Last Name:RUDNICKI
Suffix:
Gender:F
Credentials:LAC, MS, NCCAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 SOUTHWESTERN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1236
Mailing Address - Country:US
Mailing Address - Phone:530-412-1213
Mailing Address - Fax:
Practice Address - Street 1:3065 SOUTHWESTERN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1239
Practice Address - Country:US
Practice Address - Phone:530-412-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9336171100000X
NY007256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist