Provider Demographics
NPI:1730133356
Name:CASSADAY, BRANDI SUE (PA)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:SUE
Last Name:CASSADAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-4281
Mailing Address - Country:US
Mailing Address - Phone:309-796-2329
Mailing Address - Fax:309-796-1146
Practice Address - Street 1:520 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6152
Practice Address - Country:US
Practice Address - Phone:309-762-3621
Practice Address - Fax:309-762-3690
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL363A00000X
IL085003001363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA99958OtherWELLMARK
ILP00605023OtherMEDICARE RAILROAD
ILK48296Medicare PIN
ILP00605023OtherMEDICARE RAILROAD
Q25739Medicare UPIN