Healthcare Provider Details

I. General information

NPI: 1750212296
Provider Name (Legal Business Name): MRS. ANNETTA MASENDU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5431 S VERSAILLES ST
AURORA CO
80015-6526
US

IV. Provider business mailing address

5431 S VERSAILLES ST
AURORA CO
80015-6526
US

V. Phone/Fax

Practice location:
  • Phone: 303-241-0260
  • Fax:
Mailing address:
  • Phone: 303-241-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: