Provider Demographics
NPI:1235585548
Name:MACKAY, SHANNON ELISE (DO)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ELISE
Last Name:MACKAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:MAZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7700 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2602
Mailing Address - Country:US
Mailing Address - Phone:303-730-8900
Mailing Address - Fax:303-734-2038
Practice Address - Street 1:7700 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122
Practice Address - Country:US
Practice Address - Phone:303-730-8900
Practice Address - Fax:303-734-2038
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0062368207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine