Healthcare Provider Details

I. General information

NPI: 1477850667
Provider Name (Legal Business Name): THOMANDRA SHAVAUN SAM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 S BEELER ST STE 110
DENVER CO
80237-1802
US

IV. Provider business mailing address

11402 GALWAY GROVE DR
HOUSTON TX
77047-1540
US

V. Phone/Fax

Practice location:
  • Phone: 720-347-8559
  • Fax:
Mailing address:
  • Phone: 337-351-6561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0005019
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: