Provider Demographics
NPI:1841863701
Name:WALKER, CAVALLO F
Entity type:Individual
Prefix:
First Name:CAVALLO
Middle Name:F
Last Name:WALKER
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 1:13922 PERSHING CRES
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1949
Mailing Address - Country:US
Mailing Address - Phone:917-584-0363
Mailing Address - Fax:
Practice Address - Street 1:13922 PERSHING CRES
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1949
Practice Address - Country:US
Practice Address - Phone:917-584-0363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTWZRBC986Medicaid