Healthcare Provider Details

I. General information

NPI: 1447990411
Provider Name (Legal Business Name): ELYSSA GOLDSTEIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BUCK CREEK RD STE 200
AVON CO
81620-5428
US

IV. Provider business mailing address

PO BOX 4330
AVON CO
81620-4330
US

V. Phone/Fax

Practice location:
  • Phone: 970-926-6340
  • Fax: 970-926-6348
Mailing address:
  • Phone: 970-926-6340
  • Fax: 970-926-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0071846
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: