Healthcare Provider Details

I. General information

NPI: 1801562533
Provider Name (Legal Business Name): SHIVA K MADASU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2021
Last Update Date: 08/22/2021
Certification Date: 08/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 W JEFFERSON AVE STE 100
LAKEWOOD CO
80235-2015
US

IV. Provider business mailing address

9012 VANCE ST APT 209
WESTMINSTER CO
80021-6493
US

V. Phone/Fax

Practice location:
  • Phone: 603-203-1441
  • Fax:
Mailing address:
  • Phone: 954-805-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: