| Doctor Name: | MRS. SHARICE N WALLACE |
| NPI Number: | 1699911990 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA CCC-SLP |
| License Number: | 015733-1 |
| Business Practice Address: | 9777 Queens Blvd Ph Rego Park, NY - 113743335 |
| Business Phone Number: | 7188309274 |
| Business Fax Number: | |
| Mailing Address: | 11539 144th St Fl 2, JAMAICA |
| State: | NY |
| Postal Code: | 114361043 |
| Phone Number: | 6319885431 |
| Fax Number: | |
| NPI Enumeration Date: | 12/17/2008 |
| NPI Last Update Date: | 05/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 015733-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |