Healthcare Provider Details

I. General information

NPI: 1265826408
Provider Name (Legal Business Name): STEPHANIE PRITCHARD GILLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE PRITCHARD

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE # 270
AURORA CO
80045-7106
US

IV. Provider business mailing address

13123 E 16TH AVE # 270
AURORA CO
80045-7106
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-2691
  • Fax:
Mailing address:
  • Phone: 720-777-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60140
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2080P1004X
TaxonomyPhysician Nutrition Specialist (Pediatrics)
License NumberDR.0060140
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: