Provider Demographics
NPI:1538156484
Name:QUAYLE, SEJAL S (MD)
Entity type:Individual
Prefix:DR
First Name:SEJAL
Middle Name:S
Last Name:QUAYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SEJAL
Other - Middle Name:
Other - Last Name:SONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1800 E 3RD AVE UNIT 301
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5016
Mailing Address - Country:US
Mailing Address - Phone:970-426-4222
Mailing Address - Fax:
Practice Address - Street 1:1800 E 3RD AVE UNIT 301
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5016
Practice Address - Country:US
Practice Address - Phone:970-426-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114458174400000X
CO46127208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I47720Medicare UPIN