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General NPI Number Information
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NPI Number | 1902422256
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Entity Type | Individual
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Provider Name | CASSONDRA LEIGH BARBARA FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 1751 SHERIDAN DR
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City | TONAWANDA
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State | NY
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Zip | 14223-1211
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Country | US
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Telephone | 716-541-0234
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Fax | 716-249-3765
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Provider Business Mailing Address
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Address Line | 7224 WINBERT DR
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-1449
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Country | US
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Telephone | 716-238-5831
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 345508
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License Number State | NY
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