Provider Demographics
NPI:1922320696
Name:CASSIDY, JANELLE (PA)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:
Other - Last Name:CAVALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1400 ROUTE 300
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2995
Mailing Address - Country:US
Mailing Address - Phone:845-566-6664
Mailing Address - Fax:845-566-1911
Practice Address - Street 1:1400 ROUTE 300
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2995
Practice Address - Country:US
Practice Address - Phone:845-566-6664
Practice Address - Fax:845-566-1911
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013815363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical