Healthcare Provider Details

I. General information

NPI: 1811550759
Provider Name (Legal Business Name): CASSANDRA LYNN HENDERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N GILBERT RD STE L
GILBERT AZ
85234-2327
US

IV. Provider business mailing address

1400 N GILBERT RD STE L
GILBERT AZ
85234-2327
US

V. Phone/Fax

Practice location:
  • Phone: 480-956-2403
  • Fax: 480-956-8518
Mailing address:
  • Phone: 480-956-2403
  • Fax: 480-956-8518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number8178
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: