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Individual

SHAYNA M TISDALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
5200 DTC PKWY, SUITE 400, GREENWOOD VILLAGE, CO 80111-2709
(303) 745-0000
(303) 773-3101
Mailing address
5200 DTC PKWY, SUITE 400, GREENWOOD VILLAGE, CO 80111-2709
(303) 745-0000
(303) 773-3101

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2350
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
019216
KAISER COMMERCIAL NUMBER
CO
05
31187358
CO
Enumeration date
05/11/2007
Last updated
03/07/2016
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