Healthcare Provider Details

I. General information

NPI: 1215237979
Provider Name (Legal Business Name): CASSANDRA MARIE OTTAVIANO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 PIEDMONT ROW DR S STE 500
CHARLOTTE NC
28287-3803
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 855-501-1004
  • Fax:
Mailing address:
  • Phone: 855-501-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11588
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: