Provider Demographics
NPI:1235537432
Name:DEJESUS, CASSANDRA
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:DEJESUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12159 BOTTLEBRUSH PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1793
Mailing Address - Country:US
Mailing Address - Phone:704-649-5952
Mailing Address - Fax:
Practice Address - Street 1:245 MEMORIAL DR STE 6152
Practice Address - Street 2:
Practice Address - City:CULLOWHEE
Practice Address - State:NC
Practice Address - Zip Code:28723-8911
Practice Address - Country:US
Practice Address - Phone:704-649-5952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-21
Last Update Date:2014-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer