Provider Demographics
NPI:1669040713
Name:SHRIVER, NICHOLAS STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:STEPHEN
Last Name:SHRIVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2622
Mailing Address - Country:US
Mailing Address - Phone:979-436-0485
Mailing Address - Fax:
Practice Address - Street 1:1151 ALOHA ST STE 100
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-2833
Practice Address - Country:US
Practice Address - Phone:720-330-1305
Practice Address - Fax:720-452-2079
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10074416207V00000X
390200000X
CODR.0074825207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program