=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588296297
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARISSA DAWN CUFAUDE PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2020
-----------------------------------------------------
Last Update Date | 06/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 440 W JUBAL EARLY DR STE 240
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22601-6319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-450-2706
-----------------------------------------------------
Fax | 540-450-2741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 GREENSIDE WAY S STE 1
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360-6706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-210-5890
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------