Individual provider · Type 1 NPI

Sandra Kasumovic, PA-C

Medical Physician Assistant · Caldwell, ID

NPI number 1780009506 Active

Practice location

2716 Syringa Ln
Caldwell, ID 83605-3052

Call (208) 477-1223 Map

Mailing address

3 Makin Ln
Succasunna, NJ 07876-1111

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XPA1136 (ID)
Mental Health Counselor 101YM0800XNone listed
Physician Assistant 363A00000XPA1136 (ID)

Medical Physician Assistant: Definition to come...

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About NPI 1780009506

Sandra Kasumovic, PA-C's National Provider Identifier is 1780009506, issued on Mar 3, 2014. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Caldwell, ID. The record was last updated on Sep 1, 2026.