Provider Demographics
NPI:1821631698
Name:CASSITY, BRENDON T
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:T
Last Name:CASSITY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6069 LUCAYA WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-8825
Mailing Address - Country:US
Mailing Address - Phone:239-920-2020
Mailing Address - Fax:
Practice Address - Street 1:114 W WINCHESTER ST STE 200
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7710
Practice Address - Country:US
Practice Address - Phone:239-920-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X
UT149735287347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No251V00000XAgenciesVoluntary or Charitable