Provider Demographics
NPI:1689044653
Name:GORDON, CASSANDRA ALFREDA
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:ALFREDA
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 1:4408 1ST PL NE APT 14
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4955
Mailing Address - Country:US
Mailing Address - Phone:202-271-3951
Mailing Address - Fax:
Practice Address - Street 1:4408 1ST PL NE APT 14
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4955
Practice Address - Country:US
Practice Address - Phone:202-271-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide