Healthcare Provider Details

I. General information

NPI: 1720480577
Provider Name (Legal Business Name): MARISSA SARHADI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 S REVERE DR
MURRAY UT
84117-7230
US

IV. Provider business mailing address

5310 S REVERE DR
MURRAY UT
84117-7230
US

V. Phone/Fax

Practice location:
  • Phone: 385-414-5607
  • Fax:
Mailing address:
  • Phone: 385-414-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10224502-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number658510
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: