Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MR. CEDRIC CHARLES WALLACE, PA-C
Active Sole ProprietorMR. CEDRIC CHARLES WALLACE, PA-C is a Physician Assistant healthcare provider located in FREEPORT, New York. NPI 1891946240 is currently active in the NPPES registry. Verify at CMS.
Physician Assistant · FREEPORT, NY
Registration Details
- NPI Number
- 1891946240
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Oct 3, 2008 (17.832196323971 yrs)
- Last Updated
- Apr 2, 2021
- License
-
012591 (NY)
- Sole Proprietor
- Yes
Practice Information
- Address
-
20 COOLIDGE PLFREEPORT, NY, 115202543Browse NY providers · Browse ZIP 11520
- Phone
- 5167795996
- Primary Specialty
-
Physician Assistant
363A00000X
Other Physician Assistant Providers in FREEPORT, NY
| Name | Credential | NPI |
|---|---|---|
| NICOLE ANN LEGGIO | RPA-C | 1609817188 |
| MR. DAVID JOHNSON | — | 1902115595 |
| TEDDY HERVIAS | RPA-C | 1578830964 |
| PATRICIA MOMPOINT | PA | 1811316508 |
| JENNIFER WENDY MURGA | PA-C | 1922497221 |
| MRS. CHELSEA ELIZABETH CAVALLARO | — | 1083154793 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.