Provider Demographics
NPI:1134411838
Name:CARELLI, DYLAN SUZANNE (MA, ECSE)
Entity type:Individual
Prefix:MRS
First Name:DYLAN
Middle Name:SUZANNE
Last Name:CARELLI
Suffix:
Gender:F
Credentials:MA, ECSE
Other - Prefix:
Other - First Name:DYLAN
Other - Middle Name:SUZANNE
Other - Last Name:FORSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3470 S POPLAR ST APT 308
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2931
Mailing Address - Country:US
Mailing Address - Phone:720-280-7623
Mailing Address - Fax:
Practice Address - Street 1:9900 E ILIFF AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3462
Practice Address - Country:US
Practice Address - Phone:720-233-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
CO313544174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist