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General NPI Number Information
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NPI Number | 1710450382
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Entity Type | Individual
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Provider Name | SHELBY SANGSTER ATC
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Gender | Female
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 01/07/2019
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Provider Practice Location Address
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Address Line | 315 IGNACIO STREET
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City | IGNACIO
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State | CO
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Zip | 81137
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Country | US
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Telephone | 970-563-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 327 S CAMINO DEL RIO
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City | DURANGO
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State | CO
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Zip | 81303-7997
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT.0001915
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000033283
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License Number State | CO
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