Provider Demographics
NPI:1811709439
Name:ALLEN, CASSIDY GAYLE
Entity type:Individual
Prefix:MRS
First Name:CASSIDY
Middle Name:GAYLE
Last Name:ALLEN
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 1:12624 VALLEY VIEW LN
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7464
Mailing Address - Country:US
Mailing Address - Phone:909-499-7802
Mailing Address - Fax:
Practice Address - Street 1:306 LIBERTY VIEW LN
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2291
Practice Address - Country:US
Practice Address - Phone:434-592-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program