Provider Demographics
NPI:1235880956
Name:CIRILLO, CASEY ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:ELIZABETH
Last Name:CIRILLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:71 HIGH PINE CIR
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1775
Mailing Address - Country:US
Mailing Address - Phone:413-221-4895
Mailing Address - Fax:
Practice Address - Street 1:661 E ALTAMONTE DR STE 325
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5103
Practice Address - Country:US
Practice Address - Phone:407-303-4120
Practice Address - Fax:407-303-4124
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9117543363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant