Individual
SHASTA ROANN VAN SICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
660 GOLDEN RIDGE RD, STE. 250, GOLDEN, CO 80401-9541
(303) 233-1223
Mailing address
2801 PURCELL ST, BRIGHTON, CO 80601-3551
(303) 659-9700
(303) 558-8222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356505135
—
SD
05
—
55036724
—
CO
Enumeration date
07/11/2008
Last updated
04/24/2017
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