Provider Demographics
NPI:1871013656
Name:BANISADR, SEYED SAHAND (MD)
Entity Type:Individual
Prefix:
First Name:SEYED SAHAND
Middle Name:
Last Name:BANISADR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SEYED
Other - Middle Name:SAHAND
Other - Last Name:BANISADR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1735 S PUBLIC RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-7093
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:303-665-3397
Practice Address - Street 1:1735 S PUBLIC RD STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-7093
Practice Address - Country:US
Practice Address - Phone:303-665-3036
Practice Address - Fax:303-665-3397
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.030449208000000X
CODR0069674208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics