Provider Demographics
NPI:1336483403
Name:CASSALIA, JADE MARIE (DNP-FNP)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:MARIE
Last Name:CASSALIA
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-1812
Mailing Address - Country:US
Mailing Address - Phone:315-576-3743
Mailing Address - Fax:
Practice Address - Street 1:14 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-1812
Practice Address - Country:US
Practice Address - Phone:315-576-3743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341941363LF0000X
NY1239L001163WC1500X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355399Medicaid
NY00355862Medicaid