Individual
SYBILLE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5 EAST 98TH STREET, BOX 1206, NEW YORK, NY 10029-6574
(212) 241-7163
Mailing address
5 EAST 98TH STREET, BOX 1206, NEW YORK, NY 10029-6574
(212) 241-7163
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
208000000X
Pediatrics Physician
122478
NY
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
122478
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122478
LICENSE
NY
Enumeration date
03/01/2006
Last updated
03/26/2013
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