Healthcare Provider Details

I. General information

NPI: 1982930426
Provider Name (Legal Business Name): SARAH ELIZABETH DIXON CIPRIANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2009
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113
US

IV. Provider business mailing address

PO BOX 3208
SALT LAKE CITY UT
84110-3208
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2955
  • Fax:
Mailing address:
  • Phone: 801-587-6340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number8436469-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number8436469-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number8436469-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: