Provider Demographics
NPI:1215406004
Name:SHUKERT, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SHUKERT
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 1:8801 W BELLEVIEW AVE APT C105
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-7804
Mailing Address - Country:US
Mailing Address - Phone:720-238-6304
Mailing Address - Fax:
Practice Address - Street 1:12508 E BRIARWOOD AVE
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6764
Practice Address - Country:US
Practice Address - Phone:720-238-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst