Provider Demographics
NPI:1619175361
Name:SUNDAHL, FAYE ELLEN (DO)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:ELLEN
Last Name:SUNDAHL
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 1:7233 CHURCH RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4094
Mailing Address - Country:US
Mailing Address - Phone:303-925-4020
Mailing Address - Fax:303-925-4021
Practice Address - Street 1:7233 CHURCH RANCH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-4094
Practice Address - Country:US
Practice Address - Phone:303-925-4020
Practice Address - Fax:303-925-4021
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0054918207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program