Healthcare Provider Details

I. General information

NPI: 1508840257
Provider Name (Legal Business Name): CHERYL CAVANAUGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HEALTH PARK DR STE 100
LOUISVILLE CO
80027-4644
US

IV. Provider business mailing address

2750 BROADWAY ST
BOULDER CO
80304-3586
US

V. Phone/Fax

Practice location:
  • Phone: 303-666-2720
  • Fax: 303-666-2734
Mailing address:
  • Phone: 303-440-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36501
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: