Healthcare Provider Details

I. General information

NPI: 1336735539
Provider Name (Legal Business Name): PEDIATRIC ENDOCRINE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2020
Last Update Date: 12/12/2020
Certification Date: 12/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 4500
DENVER CO
80218-1289
US

IV. Provider business mailing address

8200 E BELLEVIEW AVE STE 510E
GREENWOOD VILLAGE CO
80111-2808
US

V. Phone/Fax

Practice location:
  • Phone: 303-783-3883
  • Fax: 303-783-3800
Mailing address:
  • Phone: 303-783-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUNIL NAYAK
Title or Position: PRESIDENT
Credential: MD
Phone: 303-783-3883