Provider Demographics
NPI:1356500292
Name:VANSCOYK-SIMON, SUSAN MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARY
Last Name:VANSCOYK-SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:MARY
Other - Last Name:VAN SCOYK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1616 17TH STREET SUITE 578
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202
Mailing Address - Country:US
Mailing Address - Phone:303-605-2881
Mailing Address - Fax:
Practice Address - Street 1:1616 17TH STREET SUITE 578
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202
Practice Address - Country:US
Practice Address - Phone:303-605-2881
Practice Address - Fax:303-628-5547
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2013-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO250112084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC91981Medicare PIN