Healthcare Provider Details

I. General information

NPI: 1639790165
Provider Name (Legal Business Name): SYSHANE LU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberV0798
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberDR.0077850
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: