1275596652 NPI number — JILL MARIE SOHAYDA MD

Table of content: BETTY YOUNG (NPI 1740169135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275596652 NPI number — JILL MARIE SOHAYDA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOHAYDA
Provider First Name:
JILL
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAUNHORST
Provider Other First Name:
JILL
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275596652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96 WILLOWLEAF DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80127-3582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-933-2297
Provider Business Mailing Address Fax Number:
855-852-7674

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8555 W BELLEVIEW AVE STE A06
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80123-7307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-973-3683
Provider Business Practice Location Address Fax Number:
855-852-7674
Provider Enumeration Date:
04/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  38688 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , with the licence number: 38688 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 33239533 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".