Provider Demographics
NPI:1245628023
Name:CASSIDY, SUSAN OLEVIA (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:OLEVIA
Last Name:CASSIDY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 8TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6917
Mailing Address - Country:US
Mailing Address - Phone:239-430-9678
Mailing Address - Fax:
Practice Address - Street 1:605 8TH AVE S
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6917
Practice Address - Country:US
Practice Address - Phone:239-430-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine