Individual
MS. SHELLY RAE SHADRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
2500 ROCKY MOUNTAIN AVE STE 2200, LOVELAND, CO 80538-9004
(970) 669-9100
(970) 669-0400
Mailing address
2500 ROCKY MOUNTAIN AVE STE 2200, LOVELAND, CO 80538-9004
(970) 669-9100
(970) 669-0400
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001565
IA
363A00000X
Physician Assistant
Primary
976
CO
363AM0700X
Medical Physician Assistant
001565
IA
363AS0400X
Surgical Physician Assistant
001565
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04139551
—
CO
01
—
POO986704
RAILROAD MEDICARE
CO
Enumeration date
11/17/2005
Last updated
10/27/2023
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