Provider Demographics
NPI:1417531039
Name:SHOAGA, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SHOAGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 LANSING ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-4611
Mailing Address - Country:US
Mailing Address - Phone:303-847-1971
Mailing Address - Fax:
Practice Address - Street 1:320 LANSING ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-4611
Practice Address - Country:US
Practice Address - Phone:303-847-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No171W00000XOther Service ProvidersContractor