Healthcare Provider Details

I. General information

NPI: 1679404669
Provider Name (Legal Business Name): ZACHARY SHEARER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 W 26TH AVE STE 30C
DENVER CO
80211-5340
US

IV. Provider business mailing address

3320 WARD ST
VIDOR TX
77662-3518
US

V. Phone/Fax

Practice location:
  • Phone: 720-306-1383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09932510
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: