Healthcare Provider Details

I. General information

NPI: 1114651247
Provider Name (Legal Business Name): RACHEL LYNN WALSH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 STATE ST
SCHENECTADY NY
12305-2414
US

IV. Provider business mailing address

121 EVERETT RD
ALBANY NY
12205-1474
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-2663
  • Fax: 518-689-3881
Mailing address:
  • Phone: 518-489-2663
  • Fax: 518-689-3881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number028515
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number028515
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: