Kyrsten Wallace, MD
Family Medicine in Syracuse, NY. Individual provider (NPI-1).
NPI number1407317472
StatusActive
Last updated in NPPESDec 13, 2022
Details
- NPI
- 1407317472
- Entity type
- Individual (NPI-1)
- Name
- Kyrsten Wallace
- Credential
- MD
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Mar 30, 2019
- Certification date
- Dec 13, 2022
- Last updated
- Dec 13, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 318197 | NY | Yes |
Practice location
750 E Adams StSyracuse, NY 13210-2306
Phone 315-464-8948
Mailing address
4900 Broad Rd Ste 3mSyracuse, NY 13215-2265
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