Healthcare Provider Details

I. General information

NPI: 1932357431
Provider Name (Legal Business Name): PAMELA SUE WILKIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 MUNGERS MILL RD
SILVER SPRINGS NY
14550-9704
US

IV. Provider business mailing address

5721 MUNGERS MILL RD
SILVER SPRINGS NY
14550-9704
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-0595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number017734-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: