Provider Demographics
NPI:1417305236
Name:TERRY, CASSANDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WESTFORD PL APT 3
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-1127
Mailing Address - Country:US
Mailing Address - Phone:207-756-9426
Mailing Address - Fax:
Practice Address - Street 1:2 WESTFORD PL APT 3
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1127
Practice Address - Country:US
Practice Address - Phone:207-756-9426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant