Individual
SUMALATHA M GUDAVALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12605 E 16TH AVE, AURORA, CO 80045-2545
(720) 848-0000
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
(303) 493-7000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
1545
CO
363A00000X
Physician Assistant
Primary
PA.0001545
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013652
KAISER-COMMERCIAL NUMBER
—
05
—
98038214
—
CO
Enumeration date
02/27/2007
Last updated
03/21/2016
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