Provider Demographics
NPI:1285127647
Name:AMIRIE, SHANNON SHABNAM (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:SHABNAM
Last Name:AMIRIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHABNAM
Other - Middle Name:
Other - Last Name:AMIRIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4123
Mailing Address - Fax:970-490-4173
Practice Address - Street 1:9475 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-7802
Practice Address - Country:US
Practice Address - Phone:303-470-4061
Practice Address - Fax:303-470-4062
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0071782207Q00000X
VA0101271423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA207Q00000XOtherFAMILY MEDICINE