Provider Demographics
NPI:1669850848
Name:WALSH, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:WALSH
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 1:331 ALBERTA DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1813
Mailing Address - Country:US
Mailing Address - Phone:716-204-5926
Mailing Address - Fax:
Practice Address - Street 1:331 ALBERTA DR
Practice Address - Street 2:SUITE 110
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1813
Practice Address - Country:US
Practice Address - Phone:716-204-5926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist