Healthcare Provider Details

I. General information

NPI: 1659042257
Provider Name (Legal Business Name): NYAISHA MONET' MCCLEAVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5623 PULPIT PEAK VW
COLORADO SPRINGS CO
80918-3954
US

IV. Provider business mailing address

2153 ARIKAREE HTS
COLORADO SPRINGS CO
80908-4300
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-3300
  • Fax:
Mailing address:
  • Phone: 757-869-4379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0002723
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: