Provider Demographics
NPI:1245428051
Name:TASSIONE, DINA D (PHD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:D
Last Name:TASSIONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SALSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3328
Mailing Address - Country:US
Mailing Address - Phone:307-250-2988
Mailing Address - Fax:
Practice Address - Street 1:1820 SALSBURY AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3328
Practice Address - Country:US
Practice Address - Phone:307-250-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY449172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker