Provider Demographics
NPI:1508823352
Name:REYNOLDS, SHAINA L (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAINA
Middle Name:L
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 E WOODMEN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-8075
Mailing Address - Country:US
Mailing Address - Phone:719-632-4455
Mailing Address - Fax:719-633-4613
Practice Address - Street 1:4190 E WOODMEN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8075
Practice Address - Country:US
Practice Address - Phone:719-632-4455
Practice Address - Fax:719-633-4613
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108703207Q00000X
TXN1426208M00000X, 207Q00000X
CO52872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00030453OtherMEDICARE RAILROAD
IL036108703Medicaid
H86346Medicare UPIN
IL036108703Medicaid