Provider Demographics
NPI:1972196178
Name:CASSELLS-THOMAS, AKILAH NAHRIANN
Entity Type:Individual
Prefix:MRS
First Name:AKILAH
Middle Name:NAHRIANN
Last Name:CASSELLS-THOMAS
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 1:146 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1304
Mailing Address - Country:US
Mailing Address - Phone:914-255-2257
Mailing Address - Fax:
Practice Address - Street 1:146 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1304
Practice Address - Country:US
Practice Address - Phone:914-255-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist