MEDICARE: KELLY GAYDOSH 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.0006502	CO

General Provider Information

NPI Number	:	1740791623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY GAYDOSH PA-C

Provider Business Mailing Address
First Line	:	7951 E MAPLEWOOD AVE STE 350
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-4758
Country	:	US
Telephone Number	:	303-930-7803
Fax Number	:	303-930-5503

Provider Business Practice Location Address
First Line	:	11750 W 2ND PL STE 160
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-1724
Country	:	US
Telephone Number	:	303-430-2700
Fax Number	:	303-430-2770

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

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	12/12/2025

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