Cassandra Lee Wallace, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9114232 Issued in FL

Practice address

7250 Beneva Rd
Sarasota, FL 34238-2806

Phone

(941) 921-0986

Fax

(941) 921-0989

NPI assigned

Jun 8, 2021

Last updated

Apr 5, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Achilles Kalnoky, MD PA

  dba Gulf Gate Family Medicine

  • General Practice Physician
  • Sarasota, FL
  • NPI 1861844342
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1356918494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 S FISKE BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554306",
            "telephone_number": "941-921-0986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7250 BENEVA RD",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342382806",
            "telephone_number": "941-921-0986",
            "fax_number": "941-921-0989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CASSANDRA",
        "middle_name": "LEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-08",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9114232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "PENDING",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113768400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Payton Walker
• Chanda Patricia Lynn Wall, O.D.
• Clayton Wall, FNP-BC
• Arlie N. Wallace, D.O.
• Carin Lynnae Wallace, FNP
• Susan Wallach
• Katy Wallis, PHARMD
• David George Wallwork, LAT
• Emily A Walser
• Douglas A Walsh Sr., D.O.

• Medical Physician Assistant in Sarasota, FL
• Providers in Sarasota, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.