Provider Demographics
NPI:1043870603
Name:COLEMAN, CASSANDRA PAULETTE
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:PAULETTE
Last Name:COLEMAN
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 1:661 BRANDYWINE ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3658
Mailing Address - Country:US
Mailing Address - Phone:240-481-6966
Mailing Address - Fax:
Practice Address - Street 1:1310 6TH ST NW APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3495
Practice Address - Country:US
Practice Address - Phone:202-234-7414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCACTIVE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant