Healthcare Provider Details

I. General information

NPI: 1053796029
Provider Name (Legal Business Name): SHAUNA IRENE FLEGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 VINE ST
DENVER CO
80206-2016
US

IV. Provider business mailing address

1 KALISA WAY STE 101
PARAMUS NJ
07652-3508
US

V. Phone/Fax

Practice location:
  • Phone: 720-270-9404
  • Fax: 877-345-3501
Mailing address:
  • Phone: 888-948-6789
  • Fax: 877-345-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1333
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: