Provider Demographics
NPI:1518543933
Name:SATO, SHANE TAKAYUKI (DPM)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:TAKAYUKI
Last Name:SATO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1465 KELLY JOHNSON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3945
Mailing Address - Country:US
Mailing Address - Phone:719-488-4664
Mailing Address - Fax:719-488-4667
Practice Address - Street 1:1465 KELLY JOHNSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3945
Practice Address - Country:US
Practice Address - Phone:719-488-4664
Practice Address - Fax:719-488-4667
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000957213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery