Provider Demographics
NPI:1093794984
Name:CLYNE, SHELLEY A (MD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:A
Last Name:CLYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:A
Other - Last Name:LEVESQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11600 W 2ND PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1527
Mailing Address - Country:US
Mailing Address - Phone:720-321-0000
Mailing Address - Fax:720-321-1759
Practice Address - Street 1:11600 W 2ND PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1527
Practice Address - Country:US
Practice Address - Phone:720-321-0000
Practice Address - Fax:720-321-1759
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39850207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1093794984OtherNPI #
CORO103008OtherGROUP ANTHEM BCBS
CO5334657OtherAETNA
CO84136530232OtherPACIFICARE
CO1215981634OtherGROUP NPI #
COLE654989OtherANTHEM BCBS
CT841365302039OtherRKY MTN HMO
CO04020541Medicaid
CO1836546009OtherCIGNA
CO70153507Medicaid
CO84136530211OtherPACIFICARE PPO
COP00381198OtherRAILROAD MEDICARE
COC508688Medicare PIN
COP00381198OtherRAILROAD MEDICARE
CO1215981634OtherGROUP NPI #