Healthcare Provider Details

I. General information

NPI: 1720923634
Provider Name (Legal Business Name): SHAYDELL ANN STAMPER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 S 700 E STE 201
SALT LAKE CITY UT
84107-3076
US

IV. Provider business mailing address

531 S 900 E APT A14
SALT LAKE CITY UT
84102-2979
US

V. Phone/Fax

Practice location:
  • Phone: 801-634-8434
  • Fax:
Mailing address:
  • Phone: 208-643-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14279405-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: