Individual
KYRSTEN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-8948
Mailing address
4900 BROAD RD STE 3M, SYRACUSE, NY 13215-2265
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
318197
NY
Other
Enumeration date
03/30/2019
Last updated
12/13/2022
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