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Individual

MRS. MICHELLE WALLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.A.CCC-A

Contact information

Practice address
375 EAST MAIN STREET STE. 17, BAYSHORE, NY 11706
(631) 665-6922
Mailing address
251 LYMAN RD, EAST PATCHOGUE, NY 11772-6249
(631) 286-9366

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
002098-1
NY

Other

Enumeration date
09/27/2006
Last updated
08/20/2008
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