Provider Demographics
NPI:1447887401
Name:WOLFF, CASSILYN MAY (MS PA-C)
Entity type:Individual
Prefix:
First Name:CASSILYN
Middle Name:MAY
Last Name:WOLFF
Suffix:
Gender:F
Credentials:MS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 S MAIN ST APT 297
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3198
Mailing Address - Country:US
Mailing Address - Phone:315-761-8105
Mailing Address - Fax:
Practice Address - Street 1:1540 STATE ROUTE 69
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-4318
Practice Address - Country:US
Practice Address - Phone:315-761-8105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025730363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant