Provider Demographics
NPI:1548976459
Name:DEANE, KASSANDRA NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:NICOLE
Last Name:DEANE
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 1:123 SUNNYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-1108
Mailing Address - Country:US
Mailing Address - Phone:724-584-2574
Mailing Address - Fax:
Practice Address - Street 1:5117 CENTRE AVE FL 2
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1862
Practice Address - Country:US
Practice Address - Phone:412-647-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant