Healthcare Provider Details

I. General information

NPI: 1609667989
Provider Name (Legal Business Name): CASSA ANDREA HAYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 WATERS PL
BRONX NY
10461-2714
US

IV. Provider business mailing address

1300 WATERS PL
BRONX NY
10461-2714
US

V. Phone/Fax

Practice location:
  • Phone: 929-348-3784
  • Fax: 929-348-3731
Mailing address:
  • Phone: 929-348-3784
  • Fax: 929-348-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR1389300
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: