Basic Information
| Provider Information | |||||||||
| NPI: | 1568807238 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENDLY | ||||||||
| FirstName: | DAWNIELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 14TH ST SW | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337703133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275885704 | ||||||||
| FaxNumber: | 7275857205 | ||||||||
| Practice Location | |||||||||
| Address1: | 1390 S POTOMAC ST STE 124 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800124529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033688611 | ||||||||
| FaxNumber: | 3033689791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2013 | ||||||||
| LastUpdateDate: | 11/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | UO3718 | FL | N | Allopathic & Osteopathic Physicians | Dermatology | 207R00000X | R2235 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207N00000X | 58337 | CO | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | C199008 | 05 | CO | MEDICAID |