Provider Demographics
NPI:1740097278
Name:WALLEY, SARILYNE GRACE
Entity type:Individual
Prefix:
First Name:SARILYNE
Middle Name:GRACE
Last Name:WALLEY
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 1:395 CARACAS DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3213
Mailing Address - Country:US
Mailing Address - Phone:321-576-3456
Mailing Address - Fax:
Practice Address - Street 1:1501 ROBERT J CONLAN BLVD NE STE 120-10
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3502
Practice Address - Country:US
Practice Address - Phone:321-677-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst