Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Wallie Kanishka, PHYSICIANASSISTANT

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1659045235

Wallie Kanishka, PHYSICIANASSISTANT is a Student in an Organized Health Care Education/Training Program in Glen Cove, New York. Practices as a sole proprietor. Registered with an NPI since 2021.

In the registry since
2021

Practice location Address checks out

25 Hitching Post Ln
Glen Cove, NY 11542-1625
Phone: (801) 918-4155
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1659045235
Entity typeIndividual (Type 1)
GenderMale
Credentials PHYSICIANASSISTANT
Sole proprietorYes
NPI enumeratedAugust 5, 2021
Last updated in NPPESAugust 5, 2021
Certification dateAugust 5, 2021

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