Provider Demographics
NPI:1801146618
Name:SMITH, CASSANDRA MELENICE
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MELENICE
Last Name:SMITH
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 1:1200 N CAPITOL ST NW
Mailing Address - Street 2:A413
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7503
Mailing Address - Country:US
Mailing Address - Phone:202-696-3234
Mailing Address - Fax:
Practice Address - Street 1:1836 TUBMAN ROAD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2851
Practice Address - Country:US
Practice Address - Phone:202-290-3256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide