Healthcare Provider Details

I. General information

NPI: 1063334159
Provider Name (Legal Business Name): SHANNON LEA MACCABE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S COLORADO BLVD STE 600
DENVER CO
80246-1239
US

IV. Provider business mailing address

669 N WASHINGTON ST APT 803
DENVER CO
80203-3837
US

V. Phone/Fax

Practice location:
  • Phone: 720-724-3668
  • Fax:
Mailing address:
  • Phone: 720-217-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1002217-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: