Provider Demographics
NPI:1922150176
Name:ROITHMAYR, SHELBY JANAE (MA)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:JANAE
Last Name:ROITHMAYR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:JANAE
Other - Last Name:BIARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1 MERCADO ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7310
Mailing Address - Country:US
Mailing Address - Phone:970-385-7272
Mailing Address - Fax:
Practice Address - Street 1:1 MERCADO ST STE 205
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7310
Practice Address - Country:US
Practice Address - Phone:970-739-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASLP12846235Z00000X
CAAU2227231H00000X
CO557231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA103191OtherMEDICARE PTAN
CO43858864Medicaid