MR. Cedric Charles Wallace, PA-C

NPI #1891946240 in Freeport, New York

Provider Information

NPI Number: 1891946240
Entity Type: Individual
Name: MR. Cedric Charles Wallace, PA-C
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Oct 3, 2008
Last Updated: Apr 2, 2021

Practice Location

Address: 20 COOLIDGE PL
City: Freeport
State: New York
ZIP Code: 11520-2543
Phone: (516) 779-5996

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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