Provider Demographics
NPI:1174742191
Name:WALKER, LESLIE Y (NP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:Y
Last Name:WALKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2443
Mailing Address - Country:US
Mailing Address - Phone:315-435-3653
Mailing Address - Fax:315-435-2835
Practice Address - Street 1:421 MONTGOMERY ST
Practice Address - Street 2:CIVIC CENTER - 9TH FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2923
Practice Address - Country:US
Practice Address - Phone:315-435-3653
Practice Address - Fax:315-435-2835
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYOF300737207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYOF300737Medicaid
NYS70272Medicare UPIN
NYBB3332Medicare ID - Type Unspecified