Provider Demographics
NPI:1508522087
Name:CASILLI, CARA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:NICOLE
Last Name:CASILLI
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 1:100 SIMMONS RD
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3627
Mailing Address - Country:US
Mailing Address - Phone:724-355-4520
Mailing Address - Fax:
Practice Address - Street 1:301 OHIO RIVER BLVD STE 203
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1300
Practice Address - Country:US
Practice Address - Phone:412-221-7640
Practice Address - Fax:412-490-9850
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA063187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant