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General NPI Number Information
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NPI Number | 1760909063
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Entity Type | Individual
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Provider Name | CASSANDRA LYNN CARNEVALE AGNP
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Gender | Female
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 08/28/2017
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Provider Practice Location Address
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Address Line | 161 RIVERSIDE DRIVE
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City | BINGHAMTON
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State | NY
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Zip | 13905
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Country | US
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Telephone | 607-760-7664
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 TALAN DRIVE
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City | ENDICOTT
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State | NY
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Zip | 13760
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Country | US
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Telephone | 607-760-7664
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F308258-1
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License Number State | NY
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