Provider Demographics
NPI:1760574008
Name:MATTHEWS-VU, SHABNUM ESTHER (MD)
Entity Type:Individual
Prefix:
First Name:SHABNUM
Middle Name:ESTHER
Last Name:MATTHEWS-VU
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 1:4190 E WOODMEN ROAD, #100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920
Mailing Address - Country:US
Mailing Address - Phone:719-632-4455
Mailing Address - Fax:719-633-4613
Practice Address - Street 1:4190 E WOODMEN ROAD, #100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-632-4455
Practice Address - Fax:719-633-4613
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42314208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16683331Medicaid
CO16683331Medicaid