Provider Demographics
NPI:1689955049
Name:SHEELY, ADAM (ACNP-BC, PMHNP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:SHEELY
Suffix:
Gender:M
Credentials:ACNP-BC, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 BEREA DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6535
Mailing Address - Country:US
Mailing Address - Phone:240-459-9624
Mailing Address - Fax:
Practice Address - Street 1:825 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5963
Practice Address - Country:US
Practice Address - Phone:720-437-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR195325363LA2100X
COAPN.0992752363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care