Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Cedric Charles Wallace, PA-C

Individual provider Physician Assistant · NPI 1891946240

Mr. Cedric Charles Wallace, PA-C is a Physician Assistant in Freeport, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2008
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

20 Coolidge Pl
Freeport, NY 11520-2543
Phone: (516) 779-5996
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 012591 (NY)

Record details

NPI number1891946240
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedOctober 3, 2008
Last updated in NPPESApril 2, 2021
Certification dateApril 2, 2021

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