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General NPI Number Information
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NPI Number | 1447540901
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Entity Type | Individual
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Provider Name | NEISHELLE DIONNE WALCOTT
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Gender | Female
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 1086 LONG RIDGE RD
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City | STAMFORD
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State | CT
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Zip | 06903-4404
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Country | US
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Telephone | 203-274-7426
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Fax | 203-720-6550
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Provider Business Mailing Address
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Address Line | 1086 LONG RIDGE RD
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City | STAMFORD
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State | CT
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Zip | 06903-4404
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Country | US
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Telephone | 203-274-7426
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Fax | 203-720-6550
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 014488-1
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License Number State | NY
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