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NPI Code Detail

MEDICARE: CASSANDRA MARIE OTTAVIANO PA

MEDICARE:   CASSANDRA MARIE OTTAVIANO  PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant014296-1NY
2363A00000XPhysician Assistant0010-11588NC

General Provider Information

NPI Number : 1215237979
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSANDRA MARIE OTTAVIANO PA
Provider Business Mailing Address
First Line : 6060 PIEDMONT ROW DR S STE 500
Second Line :
City : CHARLOTTE
State : NC
Zip : 28287-3803
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6060 PIEDMONT ROW DR S STE 500
Second Line :
City : CHARLOTTE
State : NC
Zip : 28287-3803
Country : US
Telephone Number : 980-326-3277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2010
Last Update Date : 11/06/2025

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Directions to “ CASSANDRA MARIE OTTAVIANO PA” Practice Location

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