Provider Demographics
NPI:1205209269
Name:GOLDEN, CASSANDRA (MS, RD)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 CORBEL CIR
Mailing Address - Street 2:APT 2117
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-6816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13301 CORBEL CIR
Practice Address - Street 2:APT 2117
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-6816
Practice Address - Country:US
Practice Address - Phone:239-910-2154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7408133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered