Provider Demographics
NPI:1003559980
Name:BONDAE, LAVASHA (BA)
Entity Type:Individual
Prefix:
First Name:LAVASHA
Middle Name:
Last Name:BONDAE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:LAVASHA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:2355 S LANSING ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1725
Mailing Address - Country:US
Mailing Address - Phone:720-951-1797
Mailing Address - Fax:
Practice Address - Street 1:700 POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6844
Practice Address - Country:US
Practice Address - Phone:303-360-3650
Practice Address - Fax:855-900-3378
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator