Provider Demographics
NPI:1689184707
Name:KANDRAVY, THOMAS NICHOLAS
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:NICHOLAS
Last Name:KANDRAVY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 TOWER RD APT 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8418
Mailing Address - Country:US
Mailing Address - Phone:720-534-0550
Mailing Address - Fax:720-302-2111
Practice Address - Street 1:5800 TOWER RD APT 210
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8418
Practice Address - Country:US
Practice Address - Phone:720-534-0550
Practice Address - Fax:720-302-2111
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3747P1801X, 372500000X, 372600000X, 3747A0650X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker