Healthcare Provider Details

I. General information

NPI: 1598707820
Provider Name (Legal Business Name): SHAUNA ANN LEONARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 HOLLIDAY VILLAGE PLZ STE 101
HOLLADAY UT
84117-5288
US

IV. Provider business mailing address

4640 HOLLIDAY VILLAGE PLZ STE 101
HOLLADAY UT
84117-5288
US

V. Phone/Fax

Practice location:
  • Phone: 801-878-9976
  • Fax: 720-853-5495
Mailing address:
  • Phone: 801-878-9976
  • Fax: 720-853-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number374304-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: