MEDICARE: ALEXANDRIA GAYLE SEVERINO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA.0009138	CO
2	363AM0700X	Medical Physician Assistant	MA063804	PA

General Provider Information

NPI Number	:	1215644984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRIA GAYLE SEVERINO PA-C

Provider Business Mailing Address
First Line	:	635 GARFIELD ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-4515
Country	:	US
Telephone Number	:	440-840-7612
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 S CLARKSON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-2235
Country	:	US
Telephone Number	:	303-721-7330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2022
Last Update Date	:	10/14/2025

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