Provider Demographics
NPI:1730614876
Name:SCHUCK, CASSIA CLARK
Entity type:Individual
Prefix:MS
First Name:CASSIA
Middle Name:CLARK
Last Name:SCHUCK
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 1:4400 W BRADDOCK ROAD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1010
Mailing Address - Country:US
Mailing Address - Phone:703-379-6000
Mailing Address - Fax:703-671-8897
Practice Address - Street 1:4400 W BRADDOCK ROAD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1010
Practice Address - Country:US
Practice Address - Phone:703-379-6000
Practice Address - Fax:703-671-8897
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No376G00000XNursing Service Related ProvidersNursing Home Administrator