Provider Demographics
NPI:1285247197
Name:PEETE, CASSANDRA (PA-C)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:PEETE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2462 NEW RD
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14481-9781
Mailing Address - Country:US
Mailing Address - Phone:973-534-6562
Mailing Address - Fax:
Practice Address - Street 1:158 SAWGRASS DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:NY
Practice Address - Zip Code:14620-4648
Practice Address - Country:US
Practice Address - Phone:973-534-6562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025543363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant