Provider Demographics
NPI:1902679558
Name:WAUDBY, CASSANDRA R
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:R
Last Name:WAUDBY
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 1:8000 DEVEREUX DR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7907
Mailing Address - Country:US
Mailing Address - Phone:386-279-1315
Mailing Address - Fax:
Practice Address - Street 1:8000 DEVEREUX DR UNIT 6
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7907
Practice Address - Country:US
Practice Address - Phone:386-279-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health