Provider Demographics
NPI:1356213268
Name:CACCESE, RACHAEL ANN
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANN
Last Name:CACCESE
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 1:3096 QUAKAKE RD
Mailing Address - Street 2:
Mailing Address - City:WEATHERLY
Mailing Address - State:PA
Mailing Address - Zip Code:18255-3212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1851 W END AVE STE A
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2050
Practice Address - Country:US
Practice Address - Phone:570-449-8684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA067109363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant