Provider Demographics
NPI:1033171715
Name:DAVIS, CASSANDA C (MD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDA
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CASSANDA
Other - Middle Name:S
Other - Last Name:CAPREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1805 SHEA CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2277
Mailing Address - Country:US
Mailing Address - Phone:303-330-0410
Mailing Address - Fax:303-330-0732
Practice Address - Street 1:24300 E SMOKY HILL RD UNIT 120
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1387
Practice Address - Country:US
Practice Address - Phone:303-330-0410
Practice Address - Fax:303-330-0732
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13137207R00000X
CODR.0064182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01364813OtherRAILROAD MEDICARE
CO029168OtherKASIER COMMERCIAL NUMBER
NV10331171715Medicaid
P01364813OtherRAILROAD MEDICARE
NV10331171715Medicaid
KS200366060IMedicaid
NVDL644ZMedicare PIN
KSI49313Medicare UPIN