Provider Demographics
NPI:1326455791
Name:DESTEFANO, CASSANDRA S (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:S
Last Name:DESTEFANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2310 PATTON RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-9154
Mailing Address - Country:US
Mailing Address - Phone:717-724-6500
Mailing Address - Fax:717-724-6510
Practice Address - Street 1:2310 PATTON RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-9154
Practice Address - Country:US
Practice Address - Phone:717-724-6500
Practice Address - Fax:717-724-6510
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056943363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical