Healthcare Provider Details

I. General information

NPI: 1659931756
Provider Name (Legal Business Name): LYDIA CHANEL SHEMWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 MARSHALL STREET SUITE 104 AND 204
ARVADA CO
80002
US

IV. Provider business mailing address

5275 MARSHALL STREET SUITE 104 AND 204
ARVADA CO
80002
US

V. Phone/Fax

Practice location:
  • Phone: 928-587-9198
  • Fax: 628-288-7758
Mailing address:
  • Phone: 928-587-9198
  • Fax: 628-288-7758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-35827
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: