Provider Demographics
NPI:1467997437
Name:CASSAGLIA, SUSANA (NP, MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:
Last Name:CASSAGLIA
Suffix:
Gender:F
Credentials:NP, MD
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:
Other - Last Name:CASSAGLIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP, MD
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-383-1040
Mailing Address - Fax:
Practice Address - Street 1:1833 BOULEVARD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4382
Practice Address - Country:US
Practice Address - Phone:904-383-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP0016X
PR22543208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)