Provider Demographics
NPI:1114575024
Name:SHELEST, PETRA
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:
Last Name:SHELEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52671 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80136-8084
Mailing Address - Country:US
Mailing Address - Phone:303-622-4689
Mailing Address - Fax:
Practice Address - Street 1:52671 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:CO
Practice Address - Zip Code:80136-8084
Practice Address - Country:US
Practice Address - Phone:303-622-4689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider