Provider Demographics
NPI:1760764682
Name:WHITNEY, CASIA JOYCE (PA)
Entity Type:Individual
Prefix:
First Name:CASIA
Middle Name:JOYCE
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CASIA
Other - Middle Name:JOYCE
Other - Last Name:MOFFATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-0553
Mailing Address - Fax:
Practice Address - Street 1:300 WHITE SPRUCE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1606
Practice Address - Country:US
Practice Address - Phone:585-424-6770
Practice Address - Fax:585-424-6776
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015120363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03527828Medicaid
NYJ400057449/GRP70008AMedicare PIN