Provider Demographics
NPI:1255063285
Name:MUNGOVAN, SHANNON (WHNP-BC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MUNGOVAN
Suffix:
Gender:
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:O'GORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4230 BEAUTIFUL CIR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-4549
Mailing Address - Country:US
Mailing Address - Phone:203-733-8331
Mailing Address - Fax:
Practice Address - Street 1:2801 YOUNGFIELD ST STE 200
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2202
Practice Address - Country:US
Practice Address - Phone:303-940-1867
Practice Address - Fax:303-940-1894
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999062-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health