Provider Demographics
NPI:1609547439
Name:GOLDMAN, CASSANDRA CASABONNE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:CASABONNE
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BROOKFORD RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1759
Mailing Address - Country:US
Mailing Address - Phone:518-590-6561
Mailing Address - Fax:
Practice Address - Street 1:321 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2611
Practice Address - Country:US
Practice Address - Phone:315-363-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant