Provider Demographics
NPI:1083977029
Name:WALTERS, FARISHA
Entity Type:Individual
Prefix:
First Name:FARISHA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBWAL
Other - Middle Name:SERVICES
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NTC-C
Mailing Address - Street 1:1 OLDWYCK CRES
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-8311
Mailing Address - Country:US
Mailing Address - Phone:914-424-9816
Mailing Address - Fax:845-827-5205
Practice Address - Street 1:1 OLDWYCK CRES
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-8311
Practice Address - Country:US
Practice Address - Phone:914-424-9816
Practice Address - Fax:845-827-5205
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY#12-1002246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic