Provider Demographics
NPI:1316287618
Name:ENO, SHAWN (CPED)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:ENO
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 17TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:IDAHO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80452-0484
Mailing Address - Country:US
Mailing Address - Phone:303-567-2271
Mailing Address - Fax:720-328-4430
Practice Address - Street 1:222 17TH AVENUE
Practice Address - Street 2:
Practice Address - City:IDAHO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80452
Practice Address - Country:US
Practice Address - Phone:303-567-2271
Practice Address - Fax:720-328-4430
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPED0697174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist