Individual
AMANDA ROSE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
525 E 68TH ST, NEW YORK, NY 10065
(212) 746-1641
Mailing address
525 E 68TH ST., BOX 140, NEW YORK, NY 10065-4870
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
144544
CA
2084P0800X
Psychiatry Physician
Primary
297971
NY
Other
Enumeration date
04/03/2015
Last updated
09/11/2019
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