MEDICARE: JADE MARIE CASSALIA DNP-FNP

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	363LF0000X	Family Nurse Practitioner	341941	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336483403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE MARIE CASSALIA DNP-FNP

Provider Business Mailing Address
First Line	:	14 WILLIAM ST
Second Line	:
City	:	SENECA FALLS
State	:	NY
Zip	:	13148-1812
Country	:	US
Telephone Number	:	315-576-3743
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 WILLIAM ST
Second Line	:
City	:	SENECA FALLS
State	:	NY
Zip	:	13148-1812
Country	:	US
Telephone Number	:	315-576-3743
Fax Number	:

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	07/21/2022

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