Provider Demographics
NPI:1528554383
Name:GLEASON, CASSANDRA L (FNP-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:L
Last Name:GLEASON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX SURG
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-8410
Mailing Address - Country:US
Mailing Address - Phone:585-275-4435
Mailing Address - Fax:585-275-8253
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-8943
Practice Address - Country:US
Practice Address - Phone:585-275-4435
Practice Address - Fax:585-276-2370
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3430612086S0120X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery