MEDICARE: SHELBY BANDEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1063260941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY BANDEL

Provider Business Mailing Address
First Line	:	12631 E 17TH AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80045-2527
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 CENTENNIAL PKWY STE 120
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1255
Country	:	US
Telephone Number	:	303-465-2323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	05/07/2024

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Directions to “ SHELBY BANDEL ” Practice Location

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