Provider Demographics
NPI:1255340006
Name:FASSINGER, MICHELLE L (PA)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:L
Last Name:FASSINGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:37 W GARDEN ST
Mailing Address - Street 2:STE 105
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2663
Mailing Address - Country:US
Mailing Address - Phone:315-685-7544
Mailing Address - Fax:315-685-7549
Practice Address - Street 1:791 W GENESEE STREET RD
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-9377
Practice Address - Country:US
Practice Address - Phone:315-685-7544
Practice Address - Fax:315-685-7549
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006816363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1248090001Medicare NSC
NYP15128Medicare UPIN