Provider Demographics
NPI:1770816308
Name:BASSFORD, CINDY CAPESTANY (PA-C, PHD)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:CAPESTANY
Last Name:BASSFORD
Suffix:
Gender:F
Credentials:PA-C, PHD
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:ANN
Other - Last Name:CAPESTANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1286 FLORIDA AVE S STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2400
Mailing Address - Country:US
Mailing Address - Phone:321-636-7780
Mailing Address - Fax:321-633-3043
Practice Address - Street 1:1286 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2484
Practice Address - Country:US
Practice Address - Phone:321-301-4747
Practice Address - Fax:321-633-3043
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9105028363A00000X
TXPA09597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0E00OtherBCBS
TX385244ZGKVMedicare PIN
FLCS751YMedicare PIN