Healthcare Provider Details

I. General information

NPI: 1548555055
Provider Name (Legal Business Name): SHAUNA LEE CHESHIRE DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2297 N HILL FIELD RD STE 103
LAYTON UT
84041-6927
US

IV. Provider business mailing address

2334 POLK AVE
OGDEN UT
84401-2044
US

V. Phone/Fax

Practice location:
  • Phone: 385-888-9040
  • Fax: 385-831-2994
Mailing address:
  • Phone: 801-564-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number289820-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: