Provider Demographics
NPI:1942876081
Name:HENRY, CASSANDRA JOSEPHINE (C-FNP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:JOSEPHINE
Last Name:HENRY
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W NORTH ST APT F
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1364
Mailing Address - Country:US
Mailing Address - Phone:315-719-2396
Mailing Address - Fax:
Practice Address - Street 1:6608 BOUGHTON HILL RD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9333
Practice Address - Country:US
Practice Address - Phone:585-440-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-30
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF04200040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily