Healthcare Provider Details

I. General information

NPI: 1063801876
Provider Name (Legal Business Name): SHELLEY ABADI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S ROUTT ST STE 250
LAKEWOOD CO
80228-2271
US

IV. Provider business mailing address

3300 N TRIUMPH BLVD STE 500
LEHI UT
84043-6475
US

V. Phone/Fax

Practice location:
  • Phone: 720-712-0300
  • Fax:
Mailing address:
  • Phone: 644-692-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.1648866
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRXN.0106343-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0997304-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: