Healthcare Provider Details

I. General information

NPI: 1134824139
Provider Name (Legal Business Name): CASSANDRA LENA FEAZELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 MAIN ST
KEESEVILLE NY
12944-3747
US

IV. Provider business mailing address

21 COGAN AVE
PLATTSBURGH NY
12901-2532
US

V. Phone/Fax

Practice location:
  • Phone: 518-834-2839
  • Fax:
Mailing address:
  • Phone: 518-569-8738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: