Provider Demographics
NPI:1619166600
Name:VELARDE, SHANNON DUSHAE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DUSHAE
Last Name:VELARDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 E 11TH AVE
Mailing Address - Street 2:#3308
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3383
Mailing Address - Country:US
Mailing Address - Phone:303-437-8762
Mailing Address - Fax:
Practice Address - Street 1:4141 E DICKENSON PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6012
Practice Address - Country:US
Practice Address - Phone:303-504-6500
Practice Address - Fax:303-504-6513
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40124164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse