Provider Demographics
NPI:1982039491
Name:BALWANT, CASSANDRA JUANITA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:JUANITA
Last Name:BALWANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:JUANITA
Other - Last Name:JAUNDOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10737 120TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2813
Mailing Address - Country:US
Mailing Address - Phone:347-806-1009
Mailing Address - Fax:
Practice Address - Street 1:10959 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2944
Practice Address - Country:US
Practice Address - Phone:407-418-9999
Practice Address - Fax:407-808-7392
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016872363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical