Provider Demographics
NPI:1891572343
Name:DEMESSIE, SISAY
Entity Type:Individual
Prefix:
First Name:SISAY
Middle Name:
Last Name:DEMESSIE
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 1:13031 E 13TH PL APT 10
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6465
Mailing Address - Country:US
Mailing Address - Phone:720-975-6901
Mailing Address - Fax:
Practice Address - Street 1:13031 E 13TH PL APT 10
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6465
Practice Address - Country:US
Practice Address - Phone:720-975-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle