Active NPI
Shivali Nayak, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Fort Collins, CO
National Provider Identifier
1487953469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- DEN.00010371
- Practice address
- 3221 Eastbrook Dr Ste a-103
Fort Collins, CO 80525-5705 - Phone
- (970) 484-4102
- NPI assigned
- Mar 16, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Certified Registered Nurse Anesthetist
- Aurora, CO
- NPI 1750769295
-
- General Practice Dentistry
- Thornton, CO
- NPI 1407947716
General Practice
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN-10371 | CO | MD | General Practice Dentistry |
| DEN.00010371 | CO | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Specialty Anesthesia Colorado, LLC | Past | Accepting new patients | |
| Thornton Youth Dentistry, PC | General Practice | Past | Accepting new patients |
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DEN-10371 | CO | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DEN.00010371 | CO | Primary |
Addresses
Primary practice location
3221 Eastbrook Dr Ste a-103
Fort Collins, CO 80525-5705
Mailing address
3221 Eastbrook Dr Ste a-103
Fort Collins, CO 80525-5705
Phone (720) 903-0558
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 86855867 | Medicaid | CO | |
| DEN.00010371 | Other | CO | CO DENTAL LICENSE |
NPI Registry JSON
{
"created_epoch": "1300233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715731200000",
"number": "1487953469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3221 EASTBROOK DR STE A-103",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805255705",
"telephone_number": "720-903-0558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3221 EASTBROOK DR STE A-103",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805255705",
"telephone_number": "970-484-4102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAYAK",
"first_name": "SHIVALI",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-16",
"last_updated": "2024-05-15",
"certification_date": "2024-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "DEN-10371",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CO",
"license": "DEN.00010371",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "86855867",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CO DENTAL LICENSE",
"identifier": "DEN.00010371",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.