Provider Demographics
NPI:1487647095
Name:MACHADO, CASSANDRA BLACK (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:BLACK
Last Name:MACHADO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:A
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-267-3000
Practice Address - Fax:717-217-4217
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN 293908L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050514OtherGROUP MEDICARE #
PA25-1716306OtherHEALTHNET/TRICARE
PAG9200081 85XWCUOtherCAREFIRST
PAPEARL PROVIDEROtherHEALTH AMERICA
PA1007307260035OtherMEDICAID GROUP #
PA120420418OtherDEPT OF LABOR
PA25-1716306OtherMULTIPLAN/PHCS
PA101291255Medicaid
PA25-1716306OtherINTERGROUP
PA253420OtherUNISON
PA50073153OtherCAPITAL BLUECROSS
PAP00458420OtherRAILROAD MEDICARE
PARN283908LOtherLICENSE
PAP00458420OtherRAILROAD MEDICARE