Provider Demographics
NPI:1346029543
Name:GORDON, SHASHANA
Entity Type:Individual
Prefix:
First Name:SHASHANA
Middle Name:
Last Name:GORDON
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 1:2613 DOUGLASS RD SE APT 301
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6568
Mailing Address - Country:US
Mailing Address - Phone:202-779-6561
Mailing Address - Fax:
Practice Address - Street 1:2613 DOUGLASS RD SE APT 301
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6568
Practice Address - Country:US
Practice Address - Phone:202-779-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty