Healthcare Provider Details

I. General information

NPI: 1255496931
Provider Name (Legal Business Name): AHARON DAVID SHULIMSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5248 PINEMONT DR SUITE C-110
MURRAY UT
84123-2702
US

IV. Provider business mailing address

1036 BELMONT AVE
SALT LAKE CITY UT
84105-1407
US

V. Phone/Fax

Practice location:
  • Phone: 801-281-3188
  • Fax: 801-262-1988
Mailing address:
  • Phone: 801-524-0134
  • Fax: 801-262-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number116417-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: