Healthcare Provider Details

I. General information

NPI: 1659275568
Provider Name (Legal Business Name): MARLAINA WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 3RD ST FL 2
RENSSELAER NY
12144-1539
US

IV. Provider business mailing address

2234 E SCHODACK RD
EAST SCHODACK NY
12063-1700
US

V. Phone/Fax

Practice location:
  • Phone: 518-463-8869
  • Fax: 518-463-8733
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: