Provider Demographics
NPI:1235636911
Name:WALTER, AIMEE LYNN
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:LYNN
Last Name:WALTER
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 1:651 MARSEILLE PATH
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1348
Mailing Address - Country:US
Mailing Address - Phone:570-872-6413
Mailing Address - Fax:
Practice Address - Street 1:651 MARSEILLE PATH
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1348
Practice Address - Country:US
Practice Address - Phone:570-872-6413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist