Provider Demographics
NPI:1528711421
Name:CASSINO, DEANNA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:CASSINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 SADDLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4839
Mailing Address - Country:US
Mailing Address - Phone:631-478-9606
Mailing Address - Fax:
Practice Address - Street 1:3203 SADDLE ROCK RD
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4839
Practice Address - Country:US
Practice Address - Phone:631-478-9606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant