Healthcare Provider Details

I. General information

NPI: 1477669471
Provider Name (Legal Business Name): CURTIS W CASSIDY M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 S FLORIDA AVE STE 2
LAKELAND FL
33801-5202
US

IV. Provider business mailing address

832 S FLORIDA AVE STE 2
LAKELAND FL
33801-5202
US

V. Phone/Fax

Practice location:
  • Phone: 863-686-0800
  • Fax: 863-686-0805
Mailing address:
  • Phone: 863-686-0800
  • Fax: 863-686-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberME86103
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME86103
License Number StateFL

VIII. Authorized Official

Name: DR. CURTIS WILLIAM CASSIDY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 863-686-0800