Healthcare Provider Details

I. General information

NPI: 1730091935
Provider Name (Legal Business Name): SORL SHEAD III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S MONACO PKWY # 204
DENVER CO
80224-3703
US

IV. Provider business mailing address

820 S MONACO PKWY # 204
DENVER CO
80224-3703
US

V. Phone/Fax

Practice location:
  • Phone: 720-232-2794
  • Fax:
Mailing address:
  • Phone: 720-232-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: