Provider Demographics
NPI:1053029686
Name:ROSS, KASANDRA (MPS)
Entity type:Individual
Prefix:
First Name:KASANDRA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MPS
Other - Prefix:
Other - First Name:KAS
Other - Middle Name:
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPS
Mailing Address - Street 1:125 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 E 23RD ST STE 402
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4547
Practice Address - Country:US
Practice Address - Phone:917-476-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist