Healthcare Provider Details

I. General information

NPI: 1629056031
Provider Name (Legal Business Name): SARA L. SHAINHOLTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA L. SHAINHOLTZ PA

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 AIRPORT RD
RIFLE CO
81650-8510
US

IV. Provider business mailing address

PO BOX 173862
DENVER CO
80217-3862
US

V. Phone/Fax

Practice location:
  • Phone: 970-625-1510
  • Fax:
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0001720
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1720
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: