MEDICARE: CASSANDRA SWAN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	383304	NY

General Provider Information

NPI Number	:	1033872999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA SWAN NP

Provider Business Mailing Address
First Line	:	416 SOUTH ST
Second Line	:
City	:	EAST AURORA
State	:	NY
Zip	:	14052-2945
Country	:	US
Telephone Number	:	315-576-7075
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 SOUTH ST
Second Line	:
City	:	EAST AURORA
State	:	NY
Zip	:	14052-2945
Country	:	US
Telephone Number	:	315-576-7075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	10/18/2021

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