Provider Demographics
NPI:1346387065
Name:CASSIDY, MICHELLE
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:CASSIDY
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 1:1241 NESHAMINY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1221
Mailing Address - Country:US
Mailing Address - Phone:267-243-5764
Mailing Address - Fax:
Practice Address - Street 1:6449 RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19111-5228
Practice Address - Country:US
Practice Address - Phone:215-745-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA27475946103TC1900X, 1223G0001X, 183500000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine