Provider Demographics
NPI:1245667245
Name:COLON, CASSANDRA F (PNP)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:F
Last Name:COLON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:F
Other - Last Name:SEGARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCP
Mailing Address - Street 1:26901 76TH AVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1433
Mailing Address - Country:US
Mailing Address - Phone:917-627-8628
Mailing Address - Fax:
Practice Address - Street 1:26901 76TH AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1433
Practice Address - Country:US
Practice Address - Phone:917-627-8628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382376-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics