Provider Demographics
NPI:1679173553
Name:KELLER, SHAYNA LOUISE (ND)
Entity type:Individual
Prefix:DR
First Name:SHAYNA
Middle Name:LOUISE
Last Name:KELLER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 W BRIDGE ST # 70
Mailing Address - Street 2:
Mailing Address - City:HOTCHKISS
Mailing Address - State:CO
Mailing Address - Zip Code:81419-3705
Mailing Address - Country:US
Mailing Address - Phone:970-549-6856
Mailing Address - Fax:
Practice Address - Street 1:310 W. BRIDGE ST.
Practice Address - Street 2:
Practice Address - City:HOTCHKISS
Practice Address - State:CO
Practice Address - Zip Code:81419
Practice Address - Country:US
Practice Address - Phone:970-315-2086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175L00000X
COND.0000206175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No175L00000XOther Service ProvidersHomeopath