Provider Demographics
NPI:1841621265
Name:WALSH, LAUREN KELLY
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:KELLY
Last Name:WALSH
Suffix:
Gender:F
Credentials:
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Other - Last Name:
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Mailing Address - Street 1:STONY BROOK UNIVERSITY DEPT OF ORTHOPEDICS
Mailing Address - Street 2:HSC T18, ROOM 080
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8181
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK UNIVERSITY DEPT OF ORTHOPEDICS
Practice Address - Street 2:HSC T18, ROOM 080
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8181
Practice Address - Country:US
Practice Address - Phone:631-444-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY016912-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant