Healthcare Provider Details

I. General information

NPI: 1487422317
Provider Name (Legal Business Name): CASSANDRA P LUNDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/20/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12735 GRAN BAY PKWY W
JACKSONVILLE FL
32258-4492
US

IV. Provider business mailing address

1627 WEST RD
JACKSONVILLE FL
32216-2848
US

V. Phone/Fax

Practice location:
  • Phone: 888-740-0398
  • Fax:
Mailing address:
  • Phone: 904-860-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: