Healthcare Provider Details

I. General information

NPI: 1093679797
Provider Name (Legal Business Name): AMANDA KOLODJI-AYOTTE M.S., L.AC.
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PONCA PL
BOULDER CO
80303-3828
US

IV. Provider business mailing address

3800 PIKE RD APT 4306
LONGMONT CO
80503-6907
US

V. Phone/Fax

Practice location:
  • Phone: 720-470-0628
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number851426
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: