Active NPI
Cassandra Wilson
- Speech-Language Pathologist
- Bayport, NY
National Provider Identifier
1972224871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 032204
- Practice address
- 150 Academy St
Bayport, NY 11705-1708 - Phone
- (631) 472-7850
- NPI assigned
- Sep 8, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 032204 | NY | Primary |
Addresses
Primary practice location
150 Academy St
Bayport, NY 11705-1708
Mailing address
10 Hemlock Rd
Mount Sinai, NY 11766-2727
Phone (631) 766-6909
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 032204 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662595200000",
"number": "1972224871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 HEMLOCK RD",
"city": "MOUNT SINAI",
"state": "NY",
"postal_code": "117662727",
"telephone_number": "631-766-6909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 ACADEMY ST",
"city": "BAYPORT",
"state": "NY",
"postal_code": "117051708",
"telephone_number": "631-472-7850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CASSANDRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-08",
"last_updated": "2022-09-08",
"certification_date": "2022-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "032204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bayport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.