Provider Demographics
NPI:1255779286
Name:TROTT, KASANDRA NICHOLE (DPM)
Entity type:Individual
Prefix:MRS
First Name:KASANDRA
Middle Name:NICHOLE
Last Name:TROTT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MISS
Other - First Name:KASANDRA
Other - Middle Name:NICHOLE
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:27 SANDY LN
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1310
Practice Address - Country:US
Practice Address - Phone:570-242-8124
Practice Address - Fax:570-363-9188
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PASC006511213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program