Provider Demographics
NPI:1053761957
Name:SHELINE, ROSS (MD)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:SHELINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 S MASON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3740
Mailing Address - Country:US
Mailing Address - Phone:970-266-3600
Mailing Address - Fax:970-266-3629
Practice Address - Street 1:4601 S MASON ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3740
Practice Address - Country:US
Practice Address - Phone:970-266-3600
Practice Address - Fax:970-266-3629
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO60652207Q00000X
OK32314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine