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General NPI Number Information
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NPI Number | 1255958831
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Entity Type | Individual
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Provider Name | CASSIDY TAYLOR PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 3401 CIVIC CENTER BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4319
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Country | US
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Telephone | 610-489-2668
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Fax |
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Provider Business Mailing Address
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Address Line | 753 N BUCKNELL ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-2505
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Country | US
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Telephone | 610-996-8414
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA061599
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License Number State | PA
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