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NPI Code Detail

MEDICARE: CASSANDRA FORTUNE MSN, MBA, RN, PMHNP

MEDICARE:   CASSANDRA  FORTUNE  MSN, MBA, RN, PMHNP
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
1163W00000XRegistered Nurse744800NY
2164W00000XLicensed Practical Nurse318569-1NY
3164W00000XLicensed Practical Nurse26NP07167800NJ
4363LP0808XPsychiatric/Mental Health Nurse Practitioner406112NY

General Provider Information

NPI Number : 1205230182
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSANDRA FORTUNE MSN, MBA, RN, PMHNP
Provider Business Mailing Address
First Line : 5 LAURA RD
Second Line :
City : MONROE
State : NY
Zip : 10950-5206
Country : US
Telephone Number : 845-659-4508
Fax Number :
Provider Business Practice Location Address
First Line : 5 LAURA RD
Second Line :
City : MONROE
State : NY
Zip : 10950-5206
Country : US
Telephone Number : 845-659-4508
Fax Number : 845-654-8645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2014
Last Update Date : 06/21/2025

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Directions to “ CASSANDRA FORTUNE MSN, MBA, RN, PMHNP” Practice Location

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