Provider Demographics
NPI:1720494685
Name:SHELINE, AMY LYNNE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:SHELINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 ZUNI ST APT 101
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-2988
Mailing Address - Country:US
Mailing Address - Phone:970-390-8409
Mailing Address - Fax:
Practice Address - Street 1:12600 ALBROOK DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-4604
Practice Address - Country:US
Practice Address - Phone:970-390-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO904936124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist