Healthcare Provider Details

I. General information

NPI: 1306580055
Provider Name (Legal Business Name): SPECTRUM NEURO BEHAVIORAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 10/02/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 BLAKE ST STE 100
DENVER CO
80205-2102
US

IV. Provider business mailing address

67 UNION ST STE 106
NATICK MA
01760-7700
US

V. Phone/Fax

Practice location:
  • Phone: 781-666-2711
  • Fax: 781-666-2712
Mailing address:
  • Phone: 781-666-2711
  • Fax: 781-666-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAWAD RIAZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 508-500-6168