Individual
IANA BRITT SANDEN SHAMAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3205 N ACADEMY BLVD, STE 100, COLORADO SPRINGS, CO 80917-5147
(719) 632-5700
Mailing address
3205 N ACADEMY BLVD, SUITE 130, COLORADO SPRINGS, CO 80917-5147
(719) 632-5700
(719) 344-7837
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2819
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09922814
—
CO
01
—
318462YLQP
MEDICARE PTAN
CO
Enumeration date
08/11/2009
Last updated
04/05/2017
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