Healthcare Provider Details

I. General information

NPI: 1821235987
Provider Name (Legal Business Name): ELIZABETH WALSH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VITALITY 3125 RTE 9W #204
NEW WINDSOR NY
12553
US

IV. Provider business mailing address

3125 US ROUTE 9W STE 204
NEW WINDSOR NY
12553-6764
US

V. Phone/Fax

Practice location:
  • Phone: 914-502-3998
  • Fax:
Mailing address:
  • Phone: 914-502-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403595
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number22566383
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: