MEDICARE: MS. CASSANDRE GUSTAVE RN

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
1	163WS0200X	School Registered Nurse	783406	NY

General Provider Information

NPI Number	:	1407550080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CASSANDRE GUSTAVE RN

Provider Business Mailing Address
First Line	:	6724 161ST ST APT 5M
Second Line	:
City	:	FRESH MEADOWS
State	:	NY
Zip	:	11365-3106
Country	:	US
Telephone Number	:	718-926-2191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1630 E 15TH ST # 201
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1192
Country	:	US
Telephone Number	:	718-724-2827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	03/28/2023

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