Healthcare Provider Details

I. General information

NPI: 1255622460
Provider Name (Legal Business Name): SHAON PRIMUS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 S 900 E
MURRAY UT
84121-1720
US

IV. Provider business mailing address

5155 S SANDPIPER DR APT 402
SALT LAKE CITY UT
84117-4725
US

V. Phone/Fax

Practice location:
  • Phone: 801-232-7138
  • Fax:
Mailing address:
  • Phone: 801-888-9640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number118439883904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: