Provider Demographics
NPI:1497028088
Name:SHEETS, CASSANDRA N (PA-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:N
Last Name:SHEETS
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 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-807-1262
Mailing Address - Fax:317-859-4268
Practice Address - Street 1:679 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1049
Practice Address - Country:US
Practice Address - Phone:317-807-1262
Practice Address - Fax:317-859-4268
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001234A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000767725OtherBLUE CROSS ANTHEM
INCD6272Medicare PIN
IN000000767725OtherBLUE CROSS ANTHEM
IN815140Medicare PIN
INM400069198Medicare PIN