Provider Demographics
NPI:1093298523
Name:GAYDEN, SHANADRA
Entity type:Individual
Prefix:
First Name:SHANADRA
Middle Name:
Last Name:GAYDEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 MILL RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-5317
Mailing Address - Country:US
Mailing Address - Phone:240-899-2753
Mailing Address - Fax:
Practice Address - Street 1:2101 MILL RD APT 109
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-5318
Practice Address - Country:US
Practice Address - Phone:240-899-2753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401229089376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide