Healthcare Provider Details

I. General information

NPI: 1093471773
Provider Name (Legal Business Name): SHELMY THACHET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 ELKTON DR STE 300
COLORADO SPRINGS CO
80907-3597
US

IV. Provider business mailing address

1115 ELKTON DR STE 300
COLORADO SPRINGS CO
80907-3597
US

V. Phone/Fax

Practice location:
  • Phone: 719-373-9703
  • Fax: 877-588-3465
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009427
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: