Provider Demographics
NPI:1083585798
Name:CASSIDY, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 BRITTLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2009
Mailing Address - Country:US
Mailing Address - Phone:510-680-9044
Mailing Address - Fax:
Practice Address - Street 1:3322 SADDLE DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:CA
Practice Address - Zip Code:94541-5728
Practice Address - Country:US
Practice Address - Phone:510-680-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACERTIFIED374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty