Provider Demographics
NPI:1962185108
Name:AYELE, TINSAE
Entity type:Individual
Prefix:
First Name:TINSAE
Middle Name:
Last Name:AYELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 LIVERPOOL ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8662
Mailing Address - Country:US
Mailing Address - Phone:720-499-7413
Mailing Address - Fax:
Practice Address - Street 1:5537 LIVERPOOL ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8662
Practice Address - Country:US
Practice Address - Phone:720-499-7413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAEBY82347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle