Active NPI
Roberta L Shanahan, PHARM D
- General Practice Physician
- Longmont, CO
National Provider Identifier
1871620880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 15986
- Practice address
- 2345 Bent Way
Longmont, CO 80503-7614 - Phone
- (303) 678-3243
- NPI assigned
- Feb 27, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 15986 | CO | Primary |
Addresses
Primary practice location
2345 Bent Way
Longmont, CO 80503-7614
Mailing address
2345 Bent Way
Longmont, CO 80503-7614
Phone (303) 678-3243
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 013254 | Other | KAISER-COMMERCIAL NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15986 | CO | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193961600000",
"number": "1871620880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2345 BENT WAY",
"city": "LONGMONT",
"state": "CO",
"postal_code": "805037614",
"telephone_number": "303-678-3243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2345 BENT WAY",
"city": "LONGMONT",
"state": "CO",
"postal_code": "805037614",
"telephone_number": "303-678-3243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANAHAN",
"first_name": "ROBERTA",
"middle_name": "L",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-27",
"last_updated": "2007-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CO",
"license": "15986",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER-COMMERCIAL NUMBER",
"identifier": "013254",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Longmont, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.