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1093794984

NPI Code Detail

MEDICARE: SHELLEY A CLYNE M.D.

MEDICARE: SHELLEY A CLYNE M.D.

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	207R00000X	Internal Medicine Physician	39850	CO
2	208M00000X	Hospitalist Physician	39850	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
12	P00381198	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1093794984	OTHER	CO	NPI #
2	RO103008	OTHER	CO	GROUP ANTHEM BCBS
3	5334657	OTHER	CO	AETNA
4	84136530232	OTHER	CO	PACIFICARE
5	1215981634	OTHER	CO	GROUP NPI #
6	LE654989	OTHER	CO	ANTHEM BCBS
7	841365302039	OTHER	CT	RKY MTN HMO
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	1836546009	OTHER	CO	CIGNA
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	84136530211	OTHER	CO	PACIFICARE PPO

General Provider Information

NPI Number	:	1093794984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY A CLYNE M.D.

Provider Business Mailing Address
First Line	:	11600 W 2ND PL
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-1527
Country	:	US
Telephone Number	:	720-321-0000
Fax Number	:	720-321-1759

Provider Business Practice Location Address
First Line	:	11600 W 2ND PL
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-1527
Country	:	US
Telephone Number	:	720-321-0000
Fax Number	:	720-321-1759

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	07/21/2022

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Practice Location Address:

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Directions to “ SHELLEY A CLYNE M.D.” Practice Location

Language	Start Address	Practice Location

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