Provider Demographics
NPI:1780150201
Name:KEANE, SHANNON M (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:KEANE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6131 S ROBB WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4736
Mailing Address - Country:US
Mailing Address - Phone:314-724-9505
Mailing Address - Fax:303-474-7848
Practice Address - Street 1:6131 S ROBB WAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4736
Practice Address - Country:US
Practice Address - Phone:314-724-9505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0994066363LF0000X, 2084P0800X
COF07181080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily