Healthcare Provider Details

I. General information

NPI: 1194189050
Provider Name (Legal Business Name): SUMA YALAMANCHILI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8580 SCARBOROUGH DR STE 225
COLORADO SPRINGS CO
80920-7586
US

IV. Provider business mailing address

8580 SCARBOROUGH DR STE 225
COLORADO SPRINGS CO
80920-7586
US

V. Phone/Fax

Practice location:
  • Phone: 719-531-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberDR.0076287
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: