Provider Demographics
NPI:1780352401
Name:SHANLEY, LINDSAY (PA-C)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:SHANLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11750 W 2ND PL STE 255
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1726
Mailing Address - Country:US
Mailing Address - Phone:720-638-7500
Mailing Address - Fax:
Practice Address - Street 1:11750 W 2ND PL STE 255
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1726
Practice Address - Country:US
Practice Address - Phone:720-638-7500
Practice Address - Fax:720-321-8041
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical