Healthcare Provider Details

I. General information

NPI: 1710332176
Provider Name (Legal Business Name): CASSANDRA DYKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 AMBLESIDE DR
CLEVELAND OH
44106-4645
US

IV. Provider business mailing address

10157 INDEPENDENCE DR
NORTH ROYALTON OH
44133-3404
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-2968
  • Fax:
Mailing address:
  • Phone: 440-638-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberPTA.10429
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: