Healthcare Provider Details

I. General information

NPI: 1538480983
Provider Name (Legal Business Name): STEPHANIE SKUBY CHASSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13121 E 17TH AVE MS 8402
AURORA CO
80045-2535
US

IV. Provider business mailing address

13121 E 17TH AVE MS 8402
AURORA CO
80045-2535
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-2867
  • Fax:
Mailing address:
  • Phone: 303-724-2867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT196942
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberTL0004998
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: