Healthcare Provider Details

I. General information

NPI: 1811629942
Provider Name (Legal Business Name): SAMUEL MASTEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 E WILMINGTON AVE
SALT LAKE CITY UT
84106-2819
US

IV. Provider business mailing address

89 E 200 S UNIT 2814
SALT LAKE CITY UT
84111-2381
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2016
  • Fax:
Mailing address:
  • Phone: 701-220-3479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number14283476-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: