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General NPI Number Information
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NPI Number | 1043328115
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Entity Type | Individual
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Provider Name | SUZANNE B. CASSIDY MD
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Gender | Female
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 2900 FRESNO ST SUITE 101
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City | FRESNO
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State | CA
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Zip | 93721-1439
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Country | US
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Telephone | 559-227-4472
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Fax | 559-227-4217
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Provider Business Mailing Address
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Address Line | 66 TOYON LN
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City | SAUSALITO
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State | CA
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Zip | 94965-1826
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Country | US
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Telephone | 415-332-0588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G85862
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | G85862
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G85862
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License Number State | CA
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