Healthcare Provider Details

I. General information

NPI: 1346797842
Provider Name (Legal Business Name): SHAILYN WOODWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

1075 E 1675 S
OGDEN UT
84404-6134
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-5613
  • Fax:
Mailing address:
  • Phone: 208-789-9620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: