Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shannon Quirk Detty, MD

Individual provider Dermatology Physician · NPI 1790149763

Shannon Quirk Detty, MD practises Dermatology in Boulder, Colorado. Graduated from Creighton University School of Medicine in 2012, 14 years ago. Practices with Dermatology Specialists of Boulder PC, a 13-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
14
Trained at
Creighton University School of Medicine
Licensed in
WI
In the registry since
2016
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2880 Folsom St Ste 200
Boulder, CO 80304-3769
Phone: (303) 442-6647
Fax: (303) 442-2696
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1056 S 88th St, Louisville, CO 80027-9460 — (303) 442-6647

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 70147 (WI)
Dermatology Physician Taxonomy 207N00000X · Licence 6600-851 (WI)

Record details

NPI number1790149763
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 6, 2016
Last updated in NPPESOctober 7, 2022
Certification dateOctober 7, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDERMATOLOGY
Medical schoolCREIGHTON UNIVERSITY SCHOOL OF MEDICINE
Graduated 2012 (14 years in practice)
Group practice Dermatology Specialists Of Boulder Pc — 13 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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