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NPI Code Detail

MEDICARE: CASSANDRA STARK

MEDICARE: CASSANDRA STARK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LW0102XWomen's Health Nurse Practitioner0991661CO

General Provider Information

NPI Number : 1033506936
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSANDRA STARK
Provider Business Mailing Address
First Line : 139 CENTRE ST PH 120
Second Line :
City : NEW YORK
State : NY
Zip : 10013-4559
Country : US
Telephone Number : 888-731-8994
Fax Number :
Provider Business Practice Location Address
First Line : 165 BROADWAY FL 23
Second Line :
City : NEW YORK
State : NY
Zip : 10006-1452
Country : US
Telephone Number : 888-731-8994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2015
Last Update Date : 12/05/2025

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Directions to “ CASSANDRA STARK ” Practice Location

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