Healthcare Provider Details

I. General information

NPI: 1356412373
Provider Name (Legal Business Name): PEDIATRIC ENDOCRINE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/12/2020
Certification Date: 12/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 E BELLEVIEW AVE SUITE 510E
GREENWOOD VILLAGE CO
80111
US

IV. Provider business mailing address

8200 E BELLEVIEW AVE SUITE 510E
GREENWOOD VILLAGE CO
80111
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNIL NAYAK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 303-783-3883