Healthcare Provider Details

I. General information

NPI: 1912784497
Provider Name (Legal Business Name): KASSANDRA RENEE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 HUTCHINSON RIVER PKWY E APT 2F
BRONX NY
10475-5431
US

IV. Provider business mailing address

4100 HUTCHINSON RIVER PKWY E APT 2F
BRONX NY
10475-5431
US

V. Phone/Fax

Practice location:
  • Phone: 347-224-4686
  • Fax:
Mailing address:
  • Phone: 347-224-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number575135
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number575135
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: