| Doctor Name: | FARISHA WALTERS |
| NPI Number: | 1083977029 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | #12-1002 |
| Business Practice Address: | 1 Oldwyck Cres Highland Mills, NY - 109308311 |
| Business Phone Number: | 9144249816 |
| Business Fax Number: | 8458275205 |
| Mailing Address: | 1 Oldwyck Cres, HIGHLAND MILLS |
| State: | NY |
| Postal Code: | 109308311 |
| Phone Number: | 9144249816 |
| Fax Number: | 8458275205 |
| NPI Enumeration Date: | 06/22/2012 |
| NPI Last Update Date: | 06/22/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246ZE0600X |
| License Number: | #12-1002 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | Electroneurodiagnostic |
| Taxonomy Definition: | |