Provider Demographics
NPI:1689454704
Name:CHANDLER, CASSIE (PA-C, RDN)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:PA-C, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 CARMEL HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8082
Mailing Address - Country:US
Mailing Address - Phone:573-200-0925
Mailing Address - Fax:
Practice Address - Street 1:320 LILLINGTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3189
Practice Address - Country:US
Practice Address - Phone:704-362-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13630363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant