Healthcare Provider Details

I. General information

NPI: 1063339760
Provider Name (Legal Business Name): CASSANDRA ASTOLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 S 14TH ST STE 312
FERNANDINA BEACH FL
32034-4742
US

IV. Provider business mailing address

95119 VENTURES CT
FERNANDINA BEACH FL
32034-9029
US

V. Phone/Fax

Practice location:
  • Phone: 850-778-7227
  • Fax:
Mailing address:
  • Phone: 850-778-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26759
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: