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General NPI Number Information
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NPI Number | 1699189035
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Entity Type | Individual
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Provider Name | CASANDRA SHERMAN THIEMAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 45 S STANFIELD RD
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City | TROY
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State | OH
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Zip | 45373-2366
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Country | US
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Telephone | 937-339-8380
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Fax | 937-335-4096
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Provider Business Mailing Address
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Address Line | 5300 FAR HILLS AVENUE
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City | DAYTON
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State | OH
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Zip | 45429-2347
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Country | US
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Telephone | 937-433-7536
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Fax | 937-433-9612
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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 | 50.003798
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License Number State | OH
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