Healthcare Provider Details

I. General information

NPI: 1285426429
Provider Name (Legal Business Name): SEAN M CASSELS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE
ALBANY NY
12208-3478
US

IV. Provider business mailing address

90 BLUE SPRUCE LN
BALLSTON LAKE NY
12019-1321
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-4000
  • Fax:
Mailing address:
  • Phone: 845-594-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number719405
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: