Basic Information
| Provider Information | |||||||||
| NPI: | 1275133506 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHERIDAN CHILDRENS HEALTHCARE SERVICES OF COLORADO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7600 W SUNRISE BLVD FL 1 | ||||||||
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| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333224115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732511132 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1338 PHAY AVE | ||||||||
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| City: | CANON CITY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812122311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192852000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2020 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | DROZDOW | ||||||||
| AuthorizedOfficialFirstName: | GILBERT | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | AO/OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9732511132 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.