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General NPI Number Information
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NPI Number | 1366828196
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Entity Type | Individual
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Provider Name | CASSANDRA SHEPHERD PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 1275 YORK AVE ROOM S-1028
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City | NEW YORK
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State | NY
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Zip | 10065-6007
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Country | US
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Telephone | 212-639-3738
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Fax |
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Provider Business Mailing Address
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Address Line | 3903 48TH ST
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City | SUNNYSIDE
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State | NY
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Zip | 11104-1021
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Country | US
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Telephone | 631-742-8261
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 018861
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License Number State | NY
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