Provider Demographics
NPI:1023415726
Name:DORAME, CASSANDRA
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:DORAME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E RAY RD STE 4A
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1777
Mailing Address - Country:US
Mailing Address - Phone:480-659-2000
Mailing Address - Fax:480-659-3201
Practice Address - Street 1:270 E HUNT HWY STE A-2
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-4962
Practice Address - Country:US
Practice Address - Phone:480-882-2222
Practice Address - Fax:480-882-2220
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5940363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical