Healthcare Provider Details

I. General information

NPI: 1982616223
Provider Name (Legal Business Name): STEPHEN H. SHEALY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 BANNOCK ST STE 300
DENVER CO
80204-4028
US

IV. Provider business mailing address

938 BANNOCK ST STE 300
DENVER CO
80204-4028
US

V. Phone/Fax

Practice location:
  • Phone: 303-914-8800
  • Fax: 303-716-3777
Mailing address:
  • Phone: 303-914-8800
  • Fax: 303-716-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number22840
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: