Individual
SARA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
887 KELLUM ST, LINDENHURST, NY 11757-1508
(631) 626-4861
Mailing address
15 SHAMROCK LN, CENTEREACH, NY 11720-3057
(631) 626-4861
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
08/12/2024
Last updated
08/12/2024
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