Provider Demographics
NPI:1023378247
Name:SCALES, KASANDRA LYNNE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:KASANDRA
Middle Name:LYNNE
Last Name:SCALES
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4763 NORSTAR BLVD
Mailing Address - Street 2:APT. 226
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4253
Mailing Address - Country:US
Mailing Address - Phone:517-927-3878
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2342
Practice Address - Country:US
Practice Address - Phone:315-464-5162
Practice Address - Fax:315-464-4613
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260284207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program