Provider Demographics
NPI:1962724112
Name:WALSH, PAMELA JANE (RN)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JANE
Last Name:WALSH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:207 HALLOCK RD
Mailing Address - Street 2:SUITE201
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3033
Mailing Address - Country:US
Mailing Address - Phone:631-689-8920
Mailing Address - Fax:631-689-8955
Practice Address - Street 1:207 HALLOCK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3033
Practice Address - Country:US
Practice Address - Phone:631-689-8920
Practice Address - Fax:631-689-8955
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153383-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse