Provider Demographics
NPI:1740908961
Name:STEWART, SHANNON (DNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 S. WADSWORTH BLVD. UNIT C
Mailing Address - Street 2:#3108
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4350
Mailing Address - Country:US
Mailing Address - Phone:720-797-5186
Mailing Address - Fax:720-405-4313
Practice Address - Street 1:1090 S. WADSWORTH BLVD. UNIT C
Practice Address - Street 2:#3108
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4350
Practice Address - Country:US
Practice Address - Phone:720-797-5186
Practice Address - Fax:720-405-4313
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00004437363LP0808X
COC-APN.0004437-C-NP363LP0808X
COC-APN.0004437363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health