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General NPI Number Information
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NPI Number | 1982039491
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Entity Type | Individual
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Provider Name | CASSANDRA JUANITA BALWANT PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 10959 W COLONIAL DR
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City | OCOEE
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State | FL
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Zip | 34761-2944
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Country | US
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Telephone | 407-418-9999
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Fax | 407-808-7392
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Provider Business Mailing Address
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Address Line | 10737 120TH ST
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-2813
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Country | US
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Telephone | 347-806-1009
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 016872
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License Number State | NY
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