Provider Demographics
NPI:1164471314
Name:LOVITT, SHELLY ANNE (MD02/09/1969)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANNE
Last Name:LOVITT
Suffix:
Gender:F
Credentials:MD02/09/1969
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:ANNE
Other - Last Name:LOVITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7150 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3048
Mailing Address - Country:US
Mailing Address - Phone:720-536-4394
Mailing Address - Fax:720-536-4397
Practice Address - Street 1:7150 E HAMPDEN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3025
Practice Address - Country:US
Practice Address - Phone:720-536-4394
Practice Address - Fax:720-536-4397
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42904207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03584330Medicaid
CO03584330Medicaid