Provider Demographics
NPI:1295039972
Name:PASSALACQUA, CASSANDRA JO
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:JO
Last Name:PASSALACQUA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:JO
Other - Last Name:MCCANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:731 PRE EMPTION RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1335
Mailing Address - Country:US
Mailing Address - Phone:315-789-6828
Mailing Address - Fax:315-789-7750
Practice Address - Street 1:731 PRE EMPTION RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1335
Practice Address - Country:US
Practice Address - Phone:315-789-6828
Practice Address - Fax:315-789-7750
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator