Healthcare Provider Details

I. General information

NPI: 1942035878
Provider Name (Legal Business Name): AMY ALEXIS SYPER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2024
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6935 W 109TH AVE APT 205
WESTMINSTER CO
80020-6443
US

IV. Provider business mailing address

6935 W 109TH AVE APT 205
WESTMINSTER CO
80020-6443
US

V. Phone/Fax

Practice location:
  • Phone: 214-924-3782
  • Fax:
Mailing address:
  • Phone: 214-924-3782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSYC.00015448
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: