Healthcare Provider Details

I. General information

NPI: 1295663078
Provider Name (Legal Business Name): SYDNEY GAYLE JOLLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12077 S 1390 W
RIVERTON UT
84065-7445
US

IV. Provider business mailing address

12077 S 1390 W
RIVERTON UT
84065-7445
US

V. Phone/Fax

Practice location:
  • Phone: 801-867-9777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: