Provider Demographics
NPI:1952540346
Name:COYLE, CASSANDRA LEE (ANP, CDE)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEE
Last Name:COYLE
Suffix:
Gender:F
Credentials:ANP, CDE
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:LEE
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, CDE
Mailing Address - Street 1:279 TROY RD
Mailing Address - Street 2:RENNSELAER COUNTY PLAZA
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-9518
Mailing Address - Country:US
Mailing Address - Phone:518-286-1922
Mailing Address - Fax:518-283-3225
Practice Address - Street 1:279 TROY RD
Practice Address - Street 2:RENNSELAER COUNTY PLAZA
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-9518
Practice Address - Country:US
Practice Address - Phone:518-286-1922
Practice Address - Fax:518-283-3225
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY470004163WD0400X
NYF306771363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator