National Provider Identifier
Kelleyayn Wallace, PA
Kelleyayn Wallace, PA is listed in the NPPES registry with a primary specialty of Physician Assistant in Rochester, NY and a listed phone number of (585) 271-2800.
Profile Overview
- NPI
- 1831290717
- Provider Type
- Individual
- Primary Specialty
- Physician Assistant
- Enumeration Date
- September 26, 2006
- Last Updated
- December 09, 2015
Practice Location
- 2080 Clinton Ave South
- Rochester, NY 14618
Phone: (585) 271-2800
Specialties
- Physician Assistant (363A00000X)
Full Record
- NPI
- 1831290717
- Entity Type
- Individual
- Last Name
- Wallace
- First Name
- Kelleyayn
- Credential
- PA
- Mailing Street Address
- 2080 Clinton Ave South
- Mailing City
- Rochester
- Mailing State
- NY
- Mailing ZIP Code
- 14618
- Mailing Country
- US
- Mailing Phone
- (585) 271-2800
- Mailing Fax
- (585) 271-0375
- Practice Street Address
- 2080 Clinton Ave South
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14618
- Practice Country
- US
- Practice Phone
- (585) 271-2800
- Practice Fax
- (585) 271-0375
- Enumeration Date
- September 26, 2006
- Last Updated
- December 09, 2015
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physician Assistant (363A00000X)
- Other Identifiers
- CF8438 (NY, Medicare Railroad), 7082043 (NY, Aetna), G0183898590 (Excellus), 02578343 (NY), 1366535940 (NY, Group NPI)