Provider Demographics
NPI:1063767895
Name:WALSH, SHEILINE RAE
Entity type:Individual
Prefix:MRS
First Name:SHEILINE
Middle Name:RAE
Last Name:WALSH
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 1:7878 LYONS ROAD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:NY
Mailing Address - Zip Code:14781
Mailing Address - Country:US
Mailing Address - Phone:716-499-6025
Mailing Address - Fax:
Practice Address - Street 1:7878 LYONS ROAD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:NY
Practice Address - Zip Code:14781
Practice Address - Country:US
Practice Address - Phone:716-499-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY679700961174400000X
NY679701961174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist