Provider Demographics
NPI:1376868968
Name:HENRY, CASSANDRA (PAC)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 SUNPORT DR STE 116
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7897
Mailing Address - Country:US
Mailing Address - Phone:407-851-0883
Mailing Address - Fax:407-857-4722
Practice Address - Street 1:8010 SUNPORT DR STE 116
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7897
Practice Address - Country:US
Practice Address - Phone:407-851-0883
Practice Address - Fax:407-857-4722
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107186363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical