Healthcare Provider Details

I. General information

NPI: 1659919785
Provider Name (Legal Business Name): KAMEEL AZEEZ SNEIJ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE STE 5001
COLORADO SPRINGS CO
80907-6865
US

IV. Provider business mailing address

2222 N NEVADA AVE STE 5001
COLORADO SPRINGS CO
80907-6865
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-3580
  • Fax: 719-776-3599
Mailing address:
  • Phone: 719-776-3580
  • Fax: 719-776-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0995235
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0995235-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: