Healthcare Provider Details

I. General information

NPI: 1245077544
Provider Name (Legal Business Name): SHAWN ALAN GREENFIELD FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 S POTOMAC ST STE 300
AURORA CO
80012-4510
US

IV. Provider business mailing address

1444 S POTOMAC ST STE 300
AURORA CO
80012-4510
US

V. Phone/Fax

Practice location:
  • Phone: 303-750-0822
  • Fax: 303-750-1298
Mailing address:
  • Phone: 303-750-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0999698-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: