Provider Demographics
NPI:1992879704
Name:HALL, SHANNA DEE (MD)
Entity type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:DEE
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9930 S UNIVERSITY BLVD 130
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126
Mailing Address - Country:US
Mailing Address - Phone:303-471-1200
Mailing Address - Fax:303-471-1455
Practice Address - Street 1:9330 S UNIVERSITY BLVD STE 130
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-5049
Practice Address - Country:US
Practice Address - Phone:303-471-1200
Practice Address - Fax:303-471-1455
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33893208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24359220Medicaid
CO24359220Medicaid
G47524Medicare UPIN