Healthcare Provider Details

I. General information

NPI: 1255205803
Provider Name (Legal Business Name): SHAUN ROBERT BOYLE FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 E ROOSEVELT AVE
SALT LAKE CITY UT
84108-2312
US

IV. Provider business mailing address

2104 E ROOSEVELT AVE
SALT LAKE CITY UT
84108-2312
US

V. Phone/Fax

Practice location:
  • Phone: 801-349-9908
  • Fax:
Mailing address:
  • Phone: 801-349-9908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07250443
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: