Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 298531 | NY |
NPI | 1336481092 |
---|---|
Provider Name | Heather Lynn Wasik |
First Address | Syracuse, NY 13212-4516 |
Second Address | Syracuse, NY 13210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 20/06/2019 |