Individual
SHYNELL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
1360 BUNTING AVE, GRAND JUNCTION, CO 81501-4320
(720) 519-2945
Mailing address
1360 BUNTING AVE, GRAND JUNCTION, CO 81501-4320
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01
NON-MEDICARE
CO
05
—
05
—
CO
Enumeration date
02/27/2023
Last updated
02/27/2023
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