Provider Demographics
NPI:1992712111
Name:CASH, CARLA MARY (NP, CNM)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MARY
Last Name:CASH
Suffix:
Gender:F
Credentials:NP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2140
Mailing Address - Country:US
Mailing Address - Phone:631-928-4726
Mailing Address - Fax:
Practice Address - Street 1:225 RABRO DRIVE EAST
Practice Address - Street 2:
Practice Address - City:HAUGGAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-854-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420505363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health