Provider Demographics
NPI:1154379212
Name:CASSIDY, ANDREW P (PA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:P
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3944 FM 620 S
Mailing Address - Street 2:STE 204
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-7166
Mailing Address - Country:US
Mailing Address - Phone:512-263-5454
Mailing Address - Fax:512-263-1272
Practice Address - Street 1:3944 FM 620 S
Practice Address - Street 2:STE 204
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-7166
Practice Address - Country:US
Practice Address - Phone:512-263-5454
Practice Address - Fax:512-263-1272
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1671213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U85548Medicare UPIN
TX8D1302Medicare PIN
TX5395390001Medicare NSC