Provider Demographics
NPI:1235519083
Name:WALSH, EVELYN PASCHALINE (MD)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:PASCHALINE
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGH STREET SUITE E2
Mailing Address - Street 2:NEULOCOGY
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203
Mailing Address - Country:US
Mailing Address - Phone:716-859-2024
Mailing Address - Fax:716-859-2430
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2021-11-02
Deactivation Date:2016-01-20
Deactivation Code:
Reactivation Date:2019-02-18
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY3042872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program