Healthcare Provider Details

I. General information

NPI: 1437042165
Provider Name (Legal Business Name): SHAPE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 ALCHEMY ST
LAS CRUCES NM
88012-0850
US

IV. Provider business mailing address

6202 ALCHEMY ST
LAS CRUCES NM
88012-0850
US

V. Phone/Fax

Practice location:
  • Phone: 575-520-2824
  • Fax:
Mailing address:
  • Phone: 575-520-2824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: JOSIAH FIELDER
Title or Position: CO-FOUNDER
Credential:
Phone: 575-520-2824