Provider Demographics
NPI:1578305066
Name:KASDAN, SHAYNA SOPHIA (MA)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:SOPHIA
Last Name:KASDAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15251 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CENTER CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55012-9640
Mailing Address - Country:US
Mailing Address - Phone:651-213-4505
Mailing Address - Fax:
Practice Address - Street 1:15251 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:CENTER CITY
Practice Address - State:MN
Practice Address - Zip Code:55012-9640
Practice Address - Country:US
Practice Address - Phone:651-213-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN307175101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)