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General NPI Number Information
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NPI Number | 1861866899
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Entity Type | Individual
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Provider Name | CASSIDY J. SANDERS PA
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Gender | Male
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 950 SPRUCE ST STE 1H
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City | LOUISVILLE
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State | CO
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Zip | 80027-1976
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Country | US
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Telephone | 720-598-1189
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Fax | 720-540-4250
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Provider Business Mailing Address
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Address Line | 354 RIDGE CIRCLE DR
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City | GRAND JUNCTION
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State | CO
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Zip | 81507-4611
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Country | US
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Telephone | 701-391-9985
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12305
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0005532
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License Number State | CO
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