MEDICARE: ANDREA SUPE PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1811621105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SUPE PA-C

Provider Business Mailing Address
First Line	:	2801 W 52ND AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80221-1259
Country	:	US
Telephone Number	:	970-690-5518
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 W 38TH AVE STE 220
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-2005
Country	:	US
Telephone Number	:	303-420-1297
Fax Number	:

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

Provider Enumeration Date	:	07/12/2022
Last Update Date	:	12/03/2024

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Directions to “ ANDREA SUPE PA-C” Practice Location

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