Provider Demographics
NPI:1134402621
Name:CONSTANTINIDES, SHANNON M (FNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:CONSTANTINIDES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:LEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:8101 E LOWRY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7195
Mailing Address - Country:US
Mailing Address - Phone:303-806-1998
Mailing Address - Fax:
Practice Address - Street 1:2446 RESEARCH PKWY STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1087
Practice Address - Country:US
Practice Address - Phone:719-623-1050
Practice Address - Fax:719-623-1051
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172141163W00000X
CONP-990337363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07454341Medicaid