Provider Demographics
NPI:1083827224
Name:MURPHY, SHAUNTAE T (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAUNTAE
Middle Name:T
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 S LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4127
Mailing Address - Country:US
Mailing Address - Phone:303-733-3764
Mailing Address - Fax:303-733-0868
Practice Address - Street 1:895 S LOGAN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4127
Practice Address - Country:US
Practice Address - Phone:303-733-3764
Practice Address - Fax:303-733-0868
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant