Provider Demographics
NPI:1679744601
Name:AYANDELE, TERESA M (PA-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:AYANDELE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:M
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 S HAVANA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1618
Mailing Address - Country:US
Mailing Address - Phone:303-338-4545
Mailing Address - Fax:
Practice Address - Street 1:280 EXEMPLA CIR
Practice Address - Street 2:DEPT OF ORTHOPEDICS
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3370
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2009363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO021242OtherKAISER COMMERCIAL NUMBER
CO22124349Medicaid
CO22124349Medicaid
COCOA103062Medicare PIN
CO021242OtherKAISER COMMERCIAL NUMBER