Provider Demographics
NPI:1750737003
Name:CARTER, SHAUNA
Entity type:Individual
Prefix:MS
First Name:SHAUNA
Middle Name:
Last Name:CARTER
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 1:50 S HAVANA ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-6446
Mailing Address - Country:US
Mailing Address - Phone:303-344-3364
Mailing Address - Fax:303-344-8836
Practice Address - Street 1:50 S HAVANA ST
Practice Address - Street 2:SUITE 504
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-6446
Practice Address - Country:US
Practice Address - Phone:303-344-3364
Practice Address - Fax:303-344-8836
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48639842Medicaid