Provider Demographics
NPI:1952450637
Name:CHAVOUSTIE, CYNTHIA TAYLOR (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:TAYLOR
Last Name:CHAVOUSTIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:HSU
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1805 SHEA CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2277
Mailing Address - Country:US
Mailing Address - Phone:303-330-0271
Mailing Address - Fax:303-330-0371
Practice Address - Street 1:9397 CROWN CREST BLVD STE 221
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8576
Practice Address - Country:US
Practice Address - Phone:303-788-8888
Practice Address - Fax:303-790-2567
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0002213363A00000X
CO2213363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14939053Medicaid
CO026062OtherKAISER COMMERCIAL NUMBER
CO026062OtherKAISER COMMERCIAL NUMBER
COC807355Medicare PIN