Provider Demographics
NPI:1326306127
Name:GANDHI, SHAYLIN S (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAYLIN
Middle Name:S
Last Name:GANDHI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 E SOUTH BOULDER RD STE C
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2304
Mailing Address - Country:US
Mailing Address - Phone:720-961-9700
Mailing Address - Fax:
Practice Address - Street 1:1335 E SOUTH BOULDER RD STE C
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2304
Practice Address - Country:US
Practice Address - Phone:720-961-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2012-0014363A00000X
COPA.0004048363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61358347Medicaid
NM61358347Medicaid