MEDICARE: CASSONDRA IRENE CALANDRILLO 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	363LA2100X	Acute Care Nurse Practitioner	F431439-1	NY

General Provider Information

NPI Number	:	1104395334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSONDRA IRENE CALANDRILLO NP

Provider Business Mailing Address
First Line	:	6701 136TH ST UNIT A
Second Line	:
City	:	KEW GARDENS HILLS
State	:	NY
Zip	:	11367-1623
Country	:	US
Telephone Number	:	917-972-8643
Fax Number	:

Provider Business Practice Location Address
First Line	:	6701 136TH ST UNIT A
Second Line	:
City	:	KEW GARDENS HILLS
State	:	NY
Zip	:	11367-1623
Country	:	US
Telephone Number	:	917-972-8643
Fax Number	:

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

Provider Enumeration Date	:	11/16/2018
Last Update Date	:	11/16/2018

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