Healthcare Provider Details

I. General information

NPI: 1346602133
Provider Name (Legal Business Name): SHANDI MICHAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 W 100 N
EPHRAIM UT
84627-2131
US

IV. Provider business mailing address

152 N 400 W
EPHRAIM UT
84627-5549
US

V. Phone/Fax

Practice location:
  • Phone: 435-283-4065
  • Fax: 435-462-8407
Mailing address:
  • Phone: 435-283-8400
  • Fax: 435-283-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1235458555
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: