Individual
TANYA B WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1068 HASTINGS ST, BALDWIN, NY 11510-4741
(516) 943-1622
Mailing address
1068 HASTINGS ST, BALDWIN, NY 11510-4741
(516) 943-1622
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/07/2023
Last updated
08/07/2023
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