MEDICARE: CASSIDY ANN REPETTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1265374268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIDY ANN REPETTO

Provider Business Mailing Address
First Line	:	140 TRENTON RD
Second Line	:
City	:	DEDHAM
State	:	MA
Zip	:	02026-5341
Country	:	US
Telephone Number	:	781-686-2755
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 TRENTON RD
Second Line	:
City	:	DEDHAM
State	:	MA
Zip	:	02026-5341
Country	:	US
Telephone Number	:	781-686-2755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “ CASSIDY ANN REPETTO ” Practice Location

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