MEDICARE: DR. CHRISTIANE NICOLE PANEY PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	10595791-2501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770137531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIANE NICOLE PANEY PSY.D.

Provider Business Mailing Address
First Line	:	7069 S HIGHLAND DR
Second Line	:	FL 3
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3724
Country	:	US
Telephone Number	:	801-441-0882
Fax Number	:

Provider Business Practice Location Address
First Line	:	7069 S HIGHLAND DR
Second Line	:	FL 3
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3724
Country	:	US
Telephone Number	:	801-441-0882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	06/30/2020

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