Provider Demographics
NPI:1144021676
Name:CASSANDRIA CLAUDINE STEPHENSON
Entity type:Organization
Organization Name:CASSANDRIA CLAUDINE STEPHENSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSANDRIA
Authorized Official - Middle Name:CLAUDINE
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:754-246-3364
Mailing Address - Street 1:959 VIA GANDALFI
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-0934
Mailing Address - Country:US
Mailing Address - Phone:754-246-3364
Mailing Address - Fax:949-703-8628
Practice Address - Street 1:4027 E SUNSET RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0215
Practice Address - Country:US
Practice Address - Phone:754-246-3364
Practice Address - Fax:949-703-8628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-21
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty