Provider Demographics
NPI:1083058788
Name:CASSIDY, GIULIANA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:GIULIANA
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 COASTAL BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7825
Mailing Address - Country:US
Mailing Address - Phone:650-919-4670
Mailing Address - Fax:
Practice Address - Street 1:1107 COASTAL BAY BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7825
Practice Address - Country:US
Practice Address - Phone:650-919-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3411363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant