MEDICARE: CASSANDRA MENELAS NP

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	163W00000X	Registered Nurse	653476	NY
2	363LF0000X	Family Nurse Practitioner	341185	NY

General Provider Information

NPI Number	:	1790034759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA MENELAS NP

Provider Business Mailing Address
First Line	:	1065 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-2417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 BEACH 20TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3502
Country	:	US
Telephone Number	:	718-471-0200
Fax Number	:

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

Provider Enumeration Date	:	09/06/2012
Last Update Date	:	02/20/2025

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