Basic Information
| Provider Information | |||||||||
| NPI: | 1265063317 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VELAZQUEZ | ||||||||
| FirstName: | CASSONDRA | ||||||||
| MiddleName: | RAQUEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 ORCHARD ST | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127541918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457966343 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 OLD TURNPIKE RD STE 307 | ||||||||
| Address2: | |||||||||
| City: | NANUET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109542530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456240260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2020 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 782321-01 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.