Provider Demographics
NPI:1619291416
Name:SHYELLE, MAURIEKE D (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURIEKE
Middle Name:D
Last Name:SHYELLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 YARMOUTH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4371
Mailing Address - Country:US
Mailing Address - Phone:303-919-9963
Mailing Address - Fax:303-997-9575
Practice Address - Street 1:75 MANHATTAN DR
Practice Address - Street 2:SUITE 4
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4254
Practice Address - Country:US
Practice Address - Phone:303-919-9963
Practice Address - Fax:303-997-9575
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF66218Medicare UPIN