Healthcare Provider Details

I. General information

NPI: 1265537971
Provider Name (Legal Business Name): CORINNE MICHELLE WALSH RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SUNNYSIDE BLVD
PLAINVIEW NY
11803-1504
US

IV. Provider business mailing address

PO BOX 159
BARRINGTON NJ
08007-0159
US

V. Phone/Fax

Practice location:
  • Phone: 888-982-8594
  • Fax:
Mailing address:
  • Phone: 888-982-8594
  • Fax: 888-920-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005933
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: