Provider Demographics
NPI:1568807238
Name:ENDLY, DAWNIELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:DAWNIELLE
Middle Name:
Last Name:ENDLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 14TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3133
Mailing Address - Country:US
Mailing Address - Phone:727-588-5704
Mailing Address - Fax:727-585-7205
Practice Address - Street 1:1390 S POTOMAC ST STE 124
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4529
Practice Address - Country:US
Practice Address - Phone:303-368-8611
Practice Address - Fax:303-368-9791
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO3718207N00000X
AZR2235207R00000X
CO58337207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC199008Medicaid