Healthcare Provider Details

I. General information

NPI: 1669263190
Provider Name (Legal Business Name): DYLAN TROY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S 1100 E STE 310
SALT LAKE CITY UT
84102-4507
US

IV. Provider business mailing address

2191 S MCCLELLAND ST APT 481
SALT LAKE CITY UT
84106-3398
US

V. Phone/Fax

Practice location:
  • Phone: 801-328-1260
  • Fax:
Mailing address:
  • Phone: 203-832-2468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1234567
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: