Healthcare Provider Details

I. General information

NPI: 1285588061
Provider Name (Legal Business Name): ALLISON WALSH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 UNDERHILL BLVD STE 175
SYOSSET NY
11791-3417
US

IV. Provider business mailing address

575 UNDERHILL BLVD STE 175
SYOSSET NY
11791-3417
US

V. Phone/Fax

Practice location:
  • Phone: 516-704-7004
  • Fax:
Mailing address:
  • Phone: 516-704-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number035377
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: