Healthcare Provider Details

I. General information

NPI: 1447185236
Provider Name (Legal Business Name): BRYCE SHIMAZAKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E 400 S STE 370
SALT LAKE CITY UT
84111-2832
US

IV. Provider business mailing address

1382 E HUDSON AVE
SALT LAKE CITY UT
84106-3430
US

V. Phone/Fax

Practice location:
  • Phone: 801-839-5734
  • Fax: 385-236-0460
Mailing address:
  • Phone: 801-839-5734
  • Fax: 385-236-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14287173-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: