Individual
SHAUNA RAE WALTER KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1411 S POTOMAC ST STE 300, AURORA, CO 80012-4539
(303) 531-4910
Mailing address
1411 S POTOMAC ST STE 300, AURORA, CO 80012-4539
(303) 531-4910
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DR.0066199
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T63857929
DRIVER'S LICENSE
VA
Enumeration date
04/15/2019
Last updated
04/26/2022
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