Healthcare Provider Details

I. General information

NPI: 1295543205
Provider Name (Legal Business Name): CASSANDRA MYNATT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5019 CURTIS DR
BIRMINGHAM AL
35215-4049
US

IV. Provider business mailing address

5019 CURTIS DR
BIRMINGHAM AL
35215-4049
US

V. Phone/Fax

Practice location:
  • Phone: 205-396-9223
  • Fax:
Mailing address:
  • Phone: 205-396-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: