Healthcare Provider Details

I. General information

NPI: 1972468544
Provider Name (Legal Business Name): ANNA EYDINOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 INTERLOCKEN BLVD STE 250
BROOMFIELD CO
80021-8040
US

IV. Provider business mailing address

224 W 35TH ST
NEW YORK NY
10001-2507
US

V. Phone/Fax

Practice location:
  • Phone: 833-646-3222
  • Fax: 833-646-3222
Mailing address:
  • Phone: 833-646-3222
  • Fax: 833-646-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: