Provider Demographics
NPI:1205230182
Name:FORTUNE, CASSANDRA (MSN, MBA, RN, PMHNP)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:MSN, MBA, RN, PMHNP
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:CHERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5 LAURA RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-5206
Mailing Address - Country:US
Mailing Address - Phone:845-659-4508
Mailing Address - Fax:
Practice Address - Street 1:5 LAURA RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-5206
Practice Address - Country:US
Practice Address - Phone:845-659-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY744800163W00000X
NY318569-1164W00000X
NJ26NP07167800164W00000X
NY406112363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse