Provider Demographics
NPI:1942613344
Name:WALKER, LISHAN JHANEALLE (MD)
Entity Type:Individual
Prefix:MRS
First Name:LISHAN
Middle Name:JHANEALLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LISHAN
Other - Middle Name:JHANEALLE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10 S POINTE LNDG STE 250
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-3483
Mailing Address - Country:US
Mailing Address - Phone:585-426-4084
Mailing Address - Fax:
Practice Address - Street 1:10 S POINTE LNDG STE 250
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-3483
Practice Address - Country:US
Practice Address - Phone:585-426-4084
Practice Address - Fax:585-723-0555
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289449207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04804317Medicaid