Healthcare Provider Details

I. General information

NPI: 1780265520
Provider Name (Legal Business Name): NICOLE CASSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOWARD AVE
NEW HAVEN CT
06519-1369
US

IV. Provider business mailing address

800 HOWARD AVE
NEW HAVEN CT
06519-1369
US

V. Phone/Fax

Practice location:
  • Phone: 877-925-3637
  • Fax:
Mailing address:
  • Phone: 877-925-3637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number82177
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: