Healthcare Provider Details

I. General information

NPI: 1134057938
Provider Name (Legal Business Name): CASSAUNDRA SELLERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SW RAMSEY AVE STE 204
GRANTS PASS OR
97527-5792
US

IV. Provider business mailing address

338 E PORTLAND ST APT 4
PHOENIX AZ
85004-1816
US

V. Phone/Fax

Practice location:
  • Phone: 541-955-5683
  • Fax:
Mailing address:
  • Phone: 727-297-8327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10011795
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: