Provider Demographics
NPI:1467870832
Name:HEISELMAN, CASSANDRA (DP, MPH)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:HEISELMAN
Suffix:
Gender:F
Credentials:DP, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GREYBARN LN APT 207
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2266
Mailing Address - Country:US
Mailing Address - Phone:330-962-5969
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS RD # HSC-9
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-2432
Practice Address - Country:US
Practice Address - Phone:631-444-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293198207V00000X, 207VM0101X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program