Healthcare Provider Details

I. General information

NPI: 1144275215
Provider Name (Legal Business Name): SHELLEY W. MOORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3519 RICHMOND DR
FORT COLLINS CO
80526-5995
US

IV. Provider business mailing address

3519 RICHMOND DR
FORT COLLINS CO
80526-5995
US

V. Phone/Fax

Practice location:
  • Phone: 970-204-0300
  • Fax: 970-221-5206
Mailing address:
  • Phone: 970-449-0951
  • Fax: 970-823-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number54549
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: