Provider Demographics
NPI:1295498046
Name:FUGO-TUTALO, CASSANDRA MARIE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MARIE
Last Name:FUGO-TUTALO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:CASSANDRA
Other - Middle Name:MARIE
Other - Last Name:TUTALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:92 OLD ROUTE 9W SUITE 100
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5485
Mailing Address - Country:US
Mailing Address - Phone:845-565-7040
Mailing Address - Fax:845-517-1924
Practice Address - Street 1:92 OLD ROUTE 9W SUITE 100
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5485
Practice Address - Country:US
Practice Address - Phone:845-565-7040
Practice Address - Fax:845-517-1924
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicaid