Provider Demographics
NPI:1609284611
Name:CHARAPATA, CHANELL
Entity Type:Individual
Prefix:
First Name:CHANELL
Middle Name:
Last Name:CHARAPATA
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 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-209-2503
Mailing Address - Fax:303-761-0803
Practice Address - Street 1:701 E HAMPDEN AVE
Practice Address - Street 2:#515
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2736
Practice Address - Country:US
Practice Address - Phone:303-209-2503
Practice Address - Fax:303-761-0803
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4024363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22989030Medicaid
CO22989030Medicaid
COP01521540Medicare PIN