Provider Demographics
NPI:1275641391
Name:SHAMOS, SUSAN (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHAMOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 S COLORADO BLVD
Mailing Address - Street 2:SUITE A210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3304
Mailing Address - Country:US
Mailing Address - Phone:303-639-5240
Mailing Address - Fax:303-639-5243
Practice Address - Street 1:1980 DAHLIA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1239
Practice Address - Country:US
Practice Address - Phone:303-758-6087
Practice Address - Fax:303-639-5243
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2714103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1417962234OtherGROUP NPI