Provider Demographics
NPI:1295375061
Name:MCDANIEL, SHELBY KAYE (LSW)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:KAYE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 N SPEER BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4239
Mailing Address - Country:US
Mailing Address - Phone:720-943-7080
Mailing Address - Fax:720-316-7577
Practice Address - Street 1:8805 W 14TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4848
Practice Address - Country:US
Practice Address - Phone:720-943-7080
Practice Address - Fax:720-316-7577
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009922835104100000X
GACSW.099279581041C0700X
CO1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker