Healthcare Provider Details

I. General information

NPI: 1912267840
Provider Name (Legal Business Name): BRIANNA SHAY MCDEVITT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA MCDEVITT RAY

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 N NEVADA AVE STE 235
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

PO BOX 911057
DENVER CO
80291-1057
US

V. Phone/Fax

Practice location:
  • Phone: 719-571-8840
  • Fax: 719-571-8845
Mailing address:
  • Phone: 888-269-7001
  • Fax: 303-764-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL2228770
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberDR.0060707
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: