Provider Demographics
NPI:1477170223
Name:GRIFFIN, CASSIDY MELVILLE
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:MELVILLE
Last Name:GRIFFIN
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 1:25 HECLA ST APT 1
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2972
Mailing Address - Country:US
Mailing Address - Phone:607-226-3531
Mailing Address - Fax:
Practice Address - Street 1:25 HECLA ST APT 1
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2972
Practice Address - Country:US
Practice Address - Phone:607-226-3531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant