Provider Demographics
NPI:1730747676
Name:SIDITSKY, RACHEL LEAH (LAC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEAH
Last Name:SIDITSKY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4975 ISLAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2494
Mailing Address - Country:US
Mailing Address - Phone:585-261-5933
Mailing Address - Fax:
Practice Address - Street 1:523 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2205
Practice Address - Country:US
Practice Address - Phone:585-261-5933
Practice Address - Fax:941-312-7852
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist