| Doctor Name: | MR. CEDRIC CHARLES WALLACE |
| NPI Number: | 1891946240 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 012591 |
| Business Practice Address: | 20 Coolidge Pl Freeport, NY - 115202543 |
| Business Phone Number: | 5167795996 |
| Business Fax Number: | |
| Mailing Address: | 20 Coolidge Pl, FREEPORT |
| State: | NY |
| Postal Code: | 115202543 |
| Phone Number: | 5167795996 |
| Fax Number: | |
| NPI Enumeration Date: | 10/03/2008 |
| NPI Last Update Date: | 11/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363A00000X |
| License Number: | 012591 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |