Healthcare Provider Details

I. General information

NPI: 1497419089
Provider Name (Legal Business Name): CASSONDRA MARIE CONRAD-CULLINAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2049 GEORGE URBAN BLVD
DEPEW NY
14043-1823
US

IV. Provider business mailing address

270 BUFFALO RD APT 16
EAST AURORA NY
14052-1367
US

V. Phone/Fax

Practice location:
  • Phone: 716-901-8808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: