Healthcare Provider Details

I. General information

NPI: 1063338275
Provider Name (Legal Business Name): MARYLL ANN BUNYI SUELTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 CAMPUS DR # 100
COLORADO SPRINGS CO
80920-3107
US

IV. Provider business mailing address

939 CANDLESTAR LOOP S
FOUNTAIN CO
80817-4120
US

V. Phone/Fax

Practice location:
  • Phone: 719-822-0900
  • Fax:
Mailing address:
  • Phone: 719-660-4133
  • Fax:

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: