Provider Demographics
NPI:1831876135
Name:WHITE, CASSANDRA ISABELLE
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ISABELLE
Last Name:WHITE
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 1:6781 GROVELAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:NY
Mailing Address - Zip Code:14462-9512
Mailing Address - Country:US
Mailing Address - Phone:158-543-5663
Mailing Address - Fax:
Practice Address - Street 1:6781 GROVELAND HILL RD
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:NY
Practice Address - Zip Code:14462-9512
Practice Address - Country:US
Practice Address - Phone:158-543-5663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY890930163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice