Provider Demographics
NPI:1669711008
Name:SCULLY, CASANDRA ANNE (FNP)
Entity type:Individual
Prefix:
First Name:CASANDRA
Middle Name:ANNE
Last Name:SCULLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5068
Mailing Address - Country:US
Mailing Address - Phone:610-481-0481
Mailing Address - Fax:610-871-7200
Practice Address - Street 1:29 N 9TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-1102
Practice Address - Country:US
Practice Address - Phone:610-481-0481
Practice Address - Fax:610-481-0486
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013497363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029801100014Medicaid
PA1029801100017Medicaid
PA1029801100005Medicaid
PA1029801100012Medicaid
PA1029801100015Medicaid
PA1029801100016Medicaid
PA1029801100004Medicaid
PA1029801100006Medicaid