Provider Demographics
NPI:1457660458
Name:WAITE, PAOLA A (L AC)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:A
Last Name:WAITE
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:PAOLA
Other - Middle Name:A
Other - Last Name:BEGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:L AC
Mailing Address - Street 1:3532 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-2007
Mailing Address - Country:US
Mailing Address - Phone:315-313-4150
Mailing Address - Fax:
Practice Address - Street 1:3532 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-2007
Practice Address - Country:US
Practice Address - Phone:315-313-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-25
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13511171100000X
NY4782171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist