Provider Demographics
NPI:1467870998
Name:PANDA, MONISHA (MD, RD)
Entity type:Individual
Prefix:DR
First Name:MONISHA
Middle Name:
Last Name:PANDA
Suffix:
Gender:F
Credentials:MD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 E 19TH AVE STE C281
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2563
Mailing Address - Country:US
Mailing Address - Phone:720-722-0272
Mailing Address - Fax:
Practice Address - Street 1:3351 EASTBROOK DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5744
Practice Address - Country:US
Practice Address - Phone:970-493-7733
Practice Address - Fax:970-493-8745
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0009882390200000X
PAMT220509390200000X
CODR.0074660207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program