Healthcare Provider Details

I. General information

NPI: 1033013107
Provider Name (Legal Business Name): CASSIADY PERARD TSSLD, CF-SLP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 COURT ST
BROOKLYN NY
11201-4405
US

IV. Provider business mailing address

8149 249TH ST
BELLEROSE NY
11426-2517
US

V. Phone/Fax

Practice location:
  • Phone: 347-479-1868
  • Fax:
Mailing address:
  • Phone: 917-929-4352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2101862261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: