Healthcare Provider Details

I. General information

NPI: 1952994568
Provider Name (Legal Business Name): PEDIATRIC PULMONARY AND SLEEP SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 LAFAYETTE AVE
WOODLAND PARK CO
80863-2445
US

IV. Provider business mailing address

9235 N UNION BLVD STE 150334
COLORADO SPRINGS CO
80920-7831
US

V. Phone/Fax

Practice location:
  • Phone: 719-638-1122
  • Fax: 719-638-1123
Mailing address:
  • Phone: 719-638-1122
  • Fax: 719-638-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA HARRIS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 719-638-1122