Provider Demographics
NPI:1801246376
Name:SISNEROS, SHAWN (LAC, DIPLOM)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:SISNEROS
Suffix:
Gender:M
Credentials:LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10925 CIRCLE POINT RD APT K-307
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2484
Mailing Address - Country:US
Mailing Address - Phone:918-691-8230
Mailing Address - Fax:
Practice Address - Street 1:2950 HAVANA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3965
Practice Address - Country:US
Practice Address - Phone:303-355-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001322171100000X
COACU.0002414171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist