MEDICARE: DR. DAWNIELLE ENDLY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	UO3718	FL
2	207R00000X	Internal Medicine Physician	R2235	AZ
3	207N00000X	Dermatology Physician	58337	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568807238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAWNIELLE ENDLY DO

Provider Business Mailing Address
First Line	:	201 14TH ST SW
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33770-3133
Country	:	US
Telephone Number	:	727-588-5704
Fax Number	:	727-585-7205

Provider Business Practice Location Address
First Line	:	1390 S POTOMAC ST STE 124
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-4529
Country	:	US
Telephone Number	:	303-368-8611
Fax Number	:	303-368-9791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	11/20/2020

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Directions to “ DR. DAWNIELLE ENDLY DO” Practice Location

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