Provider Demographics
NPI:1104710128
Name:WELLNESSYOURWAYCOLLC
Entity type:Organization
Organization Name:WELLNESSYOURWAYCOLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NP
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:720-757-2007
Mailing Address - Street 1:16286 AVALANCHE RUN
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8002
Mailing Address - Country:US
Mailing Address - Phone:720-757-2007
Mailing Address - Fax:
Practice Address - Street 1:16286 AVALANCHE RUN
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-8002
Practice Address - Country:US
Practice Address - Phone:720-757-2007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care