Provider Demographics
NPI:1396278719
Name:PATTIK, CASSIDY ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:CASSIDY
Middle Name:ELIZABETH
Last Name:PATTIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 VENTURE DR STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-3475
Mailing Address - Country:US
Mailing Address - Phone:386-761-8888
Mailing Address - Fax:386-760-8799
Practice Address - Street 1:401 VENTURE DR STE A
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3475
Practice Address - Country:US
Practice Address - Phone:386-761-8888
Practice Address - Fax:386-760-8799
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1396278719208M00000X
390200000X
FLME143069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty