Provider Demographics
NPI:1407276926
Name:UMADAS, SHIVANA DEVI
Entity Type:Individual
Prefix:
First Name:SHIVANA
Middle Name:DEVI
Last Name:UMADAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1910
Mailing Address - Country:US
Mailing Address - Phone:303-458-1361
Mailing Address - Fax:303-458-1363
Practice Address - Street 1:3380 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1910
Practice Address - Country:US
Practice Address - Phone:303-458-1361
Practice Address - Fax:303-458-1363
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO00202495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program