Healthcare Provider Details

I. General information

NPI: 1275641391
Provider Name (Legal Business Name): SUSAN SHAMOS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 DAHLIA ST
DENVER CO
80220-1239
US

IV. Provider business mailing address

1385 S COLORADO BLVD SUITE A210
DENVER CO
80222-3304
US

V. Phone/Fax

Practice location:
  • Phone: 303-758-6087
  • Fax: 303-639-5243
Mailing address:
  • Phone: 303-639-5240
  • Fax: 303-639-5243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2714
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: