MEDICARE: ARLENE VIRAY SHANKLIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	5753A	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467520064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLENE VIRAY SHANKLIN MD

Provider Business Mailing Address
First Line	:	7619 LEGACY PKWY
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82009-8660
Country	:	US
Telephone Number	:	307-266-3506
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 CHINOOK LN
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81001-1851
Country	:	US
Telephone Number	:	719-545-2746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	09/23/2022

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