Provider Demographics
NPI:1215642004
Name:DWORSHAK, SHELBY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:DWORSHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:ZAMORA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5360 N ACADEMY BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4096
Mailing Address - Country:US
Mailing Address - Phone:719-227-7477
Mailing Address - Fax:719-227-7474
Practice Address - Street 1:5360 N ACADEMY BLVD STE 130
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4096
Practice Address - Country:US
Practice Address - Phone:719-227-7477
Practice Address - Fax:719-227-7474
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional