Healthcare Provider Details

I. General information

NPI: 1619896933
Provider Name (Legal Business Name): SHAE LEE LAYTON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11713 S HIGH BERRY CIR
DRAPER UT
84020-6856
US

IV. Provider business mailing address

11713 S HIGH BERRY CIR
DRAPER UT
84020-6856
US

V. Phone/Fax

Practice location:
  • Phone: 801-505-8085
  • Fax:
Mailing address:
  • Phone: 801-505-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12076396-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: