Provider Demographics
NPI:1689718199
Name:RICHARDSON, SANYA K (AUD/CCC-A/PASC)
Entity Type:Individual
Prefix:MRS
First Name:SANYA
Middle Name:K
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:AUD/CCC-A/PASC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13123 E 16TH AVE
Mailing Address - Street 2:B630
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:720-777-5463
Mailing Address - Fax:720-777-9064
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:B630
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-5463
Practice Address - Fax:720-777-9064
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO393237600000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89904036Medicaid