Healthcare Provider Details

I. General information

NPI: 1467176115
Provider Name (Legal Business Name): CASSIDY J MCCARNS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 BROAD ST
GUILFORD CT
06437-2603
US

IV. Provider business mailing address

152 BROAD ST
GUILFORD CT
06437-2603
US

V. Phone/Fax

Practice location:
  • Phone: 203-453-5235
  • Fax: 203-453-6204
Mailing address:
  • Phone: 203-453-5235
  • Fax: 203-453-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number16152
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: