Healthcare Provider Details

I. General information

NPI: 1558613604
Provider Name (Legal Business Name): SHANNON MARIE GREENLEE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 ORCHARD PKWY
WESTMINSTER CO
80023-9206
US

IV. Provider business mailing address

14300 ORCHARD PKWY
WESTMINSTER CO
80023-9206
US

V. Phone/Fax

Practice location:
  • Phone: 303-430-5560
  • Fax: 303-430-5565
Mailing address:
  • Phone: 303-430-5560
  • Fax: 303-430-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164005726
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: