Provider Demographics
NPI:1992471551
Name:CACACE, JESSICA NICOLE (MSED)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:CACACE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CARMEN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-4813
Mailing Address - Country:US
Mailing Address - Phone:917-428-7587
Mailing Address - Fax:
Practice Address - Street 1:21 CARMEN VIEW DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-4813
Practice Address - Country:US
Practice Address - Phone:917-428-7587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist