Provider Demographics
NPI:1831576107
Name:GALLEGOS, SHANTEL MAE (NP)
Entity type:Individual
Prefix:
First Name:SHANTEL
Middle Name:MAE
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22586 E UNION CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5541
Mailing Address - Country:US
Mailing Address - Phone:719-252-5877
Mailing Address - Fax:
Practice Address - Street 1:10450 PARK MEADOWS DR STE 100
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80124-5528
Practice Address - Country:US
Practice Address - Phone:720-707-6914
Practice Address - Fax:720-712-1372
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991651-NP363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner