Provider Demographics
NPI:1881474732
Name:NELSON, CASSANDRA (DRIVER/NEMT)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DRIVER/NEMT
Other - Prefix:MR
Other - First Name:BLAIR
Other - Middle Name:
Other - Last Name:BYNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DRIVER/NEMT
Mailing Address - Street 1:2748 HOLLAND AVE
Mailing Address - Street 2:2
Mailing Address - City:THE BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8710
Mailing Address - Country:US
Mailing Address - Phone:347-589-5955
Mailing Address - Fax:
Practice Address - Street 1:2748 HOLLAND AVE
Practice Address - Street 2:2
Practice Address - City:THE BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8710
Practice Address - Country:US
Practice Address - Phone:347-589-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver