Provider Demographics
NPI:1144263179
Name:SEDILLO, ANDREW (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:SEDILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-7117
Mailing Address - Country:US
Mailing Address - Phone:303-617-2300
Mailing Address - Fax:303-617-2344
Practice Address - Street 1:1504 GALENA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-2219
Practice Address - Country:US
Practice Address - Phone:303-617-2300
Practice Address - Fax:303-617-2300
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO475482084P0800X
KY355592084P0800X
IN01060017A2084P0800X
TXK7211B2084P0800X
CO476482084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25406361Medicaid
KY64010150OtherKY MEDICAID PIN
IN000000351047OtherANTHEM PIN
IN000000351047OtherANTHEM PIN
IN000000351047OtherANTHEM PIN
IN000000351047OtherANTHEM PIN
IN145790XMedicare ID - Type Unspecified
IL$$$$$$$$$Medicaid
CO25406361Medicaid
COCOA102632Medicare PIN
KY00156001Medicare PIN
IN247890JMedicare PIN