Provider Demographics
NPI:1699189035
Name:THIEMAN, CASANDRA SHERMAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CASANDRA
Middle Name:SHERMAN
Last Name:THIEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASANDRA
Other - Middle Name:SHERMAN
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 FAR HILLS AVENUE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2347
Mailing Address - Country:US
Mailing Address - Phone:937-433-7536
Mailing Address - Fax:937-433-9612
Practice Address - Street 1:45 S STANFIELD RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2366
Practice Address - Country:US
Practice Address - Phone:937-339-8380
Practice Address - Fax:937-335-4096
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003798363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant