Healthcare Provider Details

I. General information

NPI: 1457160582
Provider Name (Legal Business Name): CASSONDRA MACHAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 863706
PLANO TX
75086-3706
US

IV. Provider business mailing address

PO BOX 863706
PLANO TX
75086-3706
US

V. Phone/Fax

Practice location:
  • Phone: 214-868-5307
  • Fax:
Mailing address:
  • Phone: 214-868-5307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1018145
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: