Provider Demographics
NPI:1861866899
Name:SANDERS, CASSIDY J (PA)
Entity type:Individual
Prefix:MR
First Name:CASSIDY
Middle Name:J
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:354 RIDGE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-4611
Mailing Address - Country:US
Mailing Address - Phone:701-391-9985
Mailing Address - Fax:
Practice Address - Street 1:950 SPRUCE ST STE 1H
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1976
Practice Address - Country:US
Practice Address - Phone:720-598-1189
Practice Address - Fax:720-540-4250
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN12305363A00000X
COPA.0005532363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant