Provider Demographics
NPI:1124275193
Name:WALDES, ELIZABETH A (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:WALDES
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:270 PARK AVE
Mailing Address - Street 2:HUNTINGTON HOSPITAL EMERGENCY DEPARTMENT
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2787
Mailing Address - Country:US
Mailing Address - Phone:631-351-2237
Mailing Address - Fax:
Practice Address - Street 1:270 PARK AVE
Practice Address - Street 2:HUNTINGTON HOSPITAL EMERGENCY DEPARTMENT
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2787
Practice Address - Country:US
Practice Address - Phone:631-760-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPA001136363A00000X
PAMA053934363A00000X
NY014625363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant