Healthcare Provider Details

I. General information

NPI: 1669040713
Provider Name (Legal Business Name): NICHOLAS STEPHEN SHRIVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 ALOHA ST STE 100
CASTLE ROCK CO
80108-2833
US

IV. Provider business mailing address

1151 ALOHA ST
CASTLE ROCK CO
80108-2833
US

V. Phone/Fax

Practice location:
  • Phone: 720-330-1305
  • Fax: 720-452-2079
Mailing address:
  • Phone: 720-330-1305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0074825
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: