Provider Demographics
NPI:1144717703
Name:SWEET, KASSANDRA
Entity type:Individual
Prefix:MS
First Name:KASSANDRA
Middle Name:
Last Name:SWEET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 BRETTS WAY
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-3215
Mailing Address - Country:US
Mailing Address - Phone:315-404-7105
Mailing Address - Fax:
Practice Address - Street 1:1203 HILTON AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4149
Practice Address - Country:US
Practice Address - Phone:315-368-6433
Practice Address - Fax:315-223-4899
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY722452163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse