Provider Demographics
NPI:1568271096
Name:PAVLACKA, ELLEN
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:PAVLACKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:SENECA CASTLE
Mailing Address - State:NY
Mailing Address - Zip Code:14547-0136
Mailing Address - Country:US
Mailing Address - Phone:315-877-6327
Mailing Address - Fax:
Practice Address - Street 1:2082 BUFFALO ST.
Practice Address - Street 2:APT 2
Practice Address - City:STANLEY
Practice Address - State:NY
Practice Address - Zip Code:14561
Practice Address - Country:US
Practice Address - Phone:315-217-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN