Provider Demographics
NPI:1346473352
Name:HALL, CASSANDRA STEPHANIE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:STEPHANIE
Last Name:HALL
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 1:33279 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGE MANOR
Mailing Address - State:FL
Mailing Address - Zip Code:33523-9041
Mailing Address - Country:US
Mailing Address - Phone:352-346-8029
Mailing Address - Fax:866-675-6298
Practice Address - Street 1:33279 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:RIDGE MANOR
Practice Address - State:FL
Practice Address - Zip Code:33523-9041
Practice Address - Country:US
Practice Address - Phone:352-346-8029
Practice Address - Fax:866-675-6298
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist