Individual
DR. SHAIN S WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5100 WEST TAFT RD, STE 2A, LIVERPOOL, NY 13088
(315) 452-2666
(315) 452-2669
Mailing address
4567 CROSSROADS PARK DR, LIVERPOOL, NY 13088-3589
(315) 295-2100
(315) 295-2125
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
264957
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/13/2010
Last updated
01/29/2024
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