Healthcare Provider Details

I. General information

NPI: 1760011506
Provider Name (Legal Business Name): SHIVANI VASUDEVA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 UNION BLVD STE 200
LAKEWOOD CO
80228-1833
US

IV. Provider business mailing address

255 UNION BLVD STE 200
LAKEWOOD CO
80228-1833
US

V. Phone/Fax

Practice location:
  • Phone: 303-763-5111
  • Fax:
Mailing address:
  • Phone: 303-763-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDR.0073295
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: