Provider Demographics
NPI:1124410634
Name:CASSIDY, CECILIA GRIFFIN (APRN, CDE)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:GRIFFIN
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:APRN, CDE
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:MARY
Other - Last Name:CRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5 CUBA HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1624
Mailing Address - Country:US
Mailing Address - Phone:631-628-5000
Mailing Address - Fax:
Practice Address - Street 1:5 CUBA HILL RD
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740
Practice Address - Country:US
Practice Address - Phone:631-628-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-21
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292979363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty