Provider Demographics
NPI:1447752902
Name:HASSEBROOK, CODY D (CPT10)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:D
Last Name:HASSEBROOK
Suffix:
Gender:M
Credentials:CPT10
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 S WASHINGTON BLVD # 227
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-6943
Mailing Address - Country:US
Mailing Address - Phone:941-822-9402
Mailing Address - Fax:
Practice Address - Street 1:242 S WASHINGTON BLVD # 227
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-6943
Practice Address - Country:US
Practice Address - Phone:941-822-9402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10527-CPT10246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy