Healthcare Provider Details

I. General information

NPI: 1760329221
Provider Name (Legal Business Name): CASSANDRA L CLERKIN RDH, COM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 CLARKS LN
MILTON NY
12547-5229
US

IV. Provider business mailing address

83 CLARKS LN
MILTON NY
12547-5229
US

V. Phone/Fax

Practice location:
  • Phone: 845-337-2234
  • Fax:
Mailing address:
  • Phone: 845-337-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number026860-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: