Healthcare Provider Details

I. General information

NPI: 1922740083
Provider Name (Legal Business Name): SHAMIM NAMAKULA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2022
Last Update Date: 06/21/2024
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S CHERRY ST STE 820
DENVER CO
80246-1325
US

IV. Provider business mailing address

501 S CHERRY ST STE 820
DENVER CO
80246-1325
US

V. Phone/Fax

Practice location:
  • Phone: 702-589-4871
  • Fax: 702-589-4872
Mailing address:
  • Phone: 702-589-4871
  • Fax: 702-589-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0997434
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: