Provider Demographics
NPI:1841458577
Name:RADCLIFF, SHANE
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:RADCLIFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 NARROW LEAF DR
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2580
Mailing Address - Country:US
Mailing Address - Phone:970-260-3228
Mailing Address - Fax:970-858-8510
Practice Address - Street 1:158 S PARK SQ
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2531
Practice Address - Country:US
Practice Address - Phone:970-260-3228
Practice Address - Fax:970-858-8510
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist