MEDICARE: CASSANDRA HENRY PAC

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	363AM0700X	Medical Physician Assistant	PA9107186	FL

General Provider Information

NPI Number	:	1376868968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA HENRY PAC

Provider Business Mailing Address
First Line	:	8010 SUNPORT DR STE 116
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7897
Country	:	US
Telephone Number	:	407-851-0883
Fax Number	:	407-857-4722

Provider Business Practice Location Address
First Line	:	8010 SUNPORT DR STE 116
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7897
Country	:	US
Telephone Number	:	407-851-0883
Fax Number	:	407-857-4722

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

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	03/01/2017

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Directions to “ CASSANDRA HENRY PAC” Practice Location

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