Healthcare Provider Details

I. General information

NPI: 1831027010
Provider Name (Legal Business Name): TAIRA DE SUTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6356 W ROSE RUN WAY
HERRIMAN UT
84096-3906
US

IV. Provider business mailing address

6356 W ROSE RUN WAY
HERRIMAN UT
84096-3906
US

V. Phone/Fax

Practice location:
  • Phone: 385-468-4487
  • Fax:
Mailing address:
  • Phone: 385-468-4487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: