Provider Demographics
NPI:1548085764
Name:MCGINN, CASSANDRA LEE (RD)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEE
Last Name:MCGINN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 46TH ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-1703
Mailing Address - Country:US
Mailing Address - Phone:631-357-0534
Mailing Address - Fax:
Practice Address - Street 1:900 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1623
Practice Address - Country:US
Practice Address - Phone:631-662-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
011376133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered