Provider Demographics
NPI:1760933642
Name:SHUSHEREBA, SHANNA (MA)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:SHUSHEREBA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 N GILPIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1206
Mailing Address - Country:US
Mailing Address - Phone:720-461-8451
Mailing Address - Fax:303-237-6873
Practice Address - Street 1:1724 N GILPIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1206
Practice Address - Country:US
Practice Address - Phone:720-461-8451
Practice Address - Fax:303-237-6873
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator