MEDICARE: NEISHELLE DIONNE WALCOTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	014488-1	NY

General Provider Information

NPI Number	:	1447540901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEISHELLE DIONNE WALCOTT

Provider Business Mailing Address
First Line	:	1086 LONG RIDGE RD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06903-4404
Country	:	US
Telephone Number	:	203-274-7426
Fax Number	:	203-720-6550

Provider Business Practice Location Address
First Line	:	1086 LONG RIDGE RD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06903-4404
Country	:	US
Telephone Number	:	203-274-7426
Fax Number	:	203-720-6550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2011
Last Update Date	:	07/21/2025

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Directions to “ NEISHELLE DIONNE WALCOTT ” Practice Location

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