Healthcare Provider Details

I. General information

NPI: 1245154038
Provider Name (Legal Business Name): SHEA SALLEE FNTP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11073 N ALPINE HWY STE 101
HIGHLAND UT
84003-8933
US

IV. Provider business mailing address

11073 N ALPINE HWY
HIGHLAND UT
84003-8927
US

V. Phone/Fax

Practice location:
  • Phone: 385-261-3064
  • Fax:
Mailing address:
  • Phone: 385-261-3064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: