Provider Demographics
NPI:1285092361
Name:GADSDEN, SHANDA
Entity type:Individual
Prefix:MRS
First Name:SHANDA
Middle Name:
Last Name:GADSDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANDA
Other - Middle Name:
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MORRIS AVE STE 103B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1423
Mailing Address - Country:US
Mailing Address - Phone:908-349-0504
Mailing Address - Fax:
Practice Address - Street 1:100 MORRIS AVE STE 103B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1423
Practice Address - Country:US
Practice Address - Phone:908-349-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00525900174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist