Healthcare Provider Details

I. General information

NPI: 1356042006
Provider Name (Legal Business Name): SHIMA DEHGHANI AHMADABAD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHIMA DEHGHANI MD

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

IV. Provider business mailing address

65 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 801-581-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number14248718-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number36636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: