Healthcare Provider Details

I. General information

NPI: 1396721015
Provider Name (Legal Business Name): APHRODITE DASKALAS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S 500 E
SALT LAKE CITY UT
84102-2030
US

IV. Provider business mailing address

501 E CHIPETA WAY
SALT LAKE CITY UT
84108-1222
US

V. Phone/Fax

Practice location:
  • Phone: 801-236-7710
  • Fax:
Mailing address:
  • Phone: 801-236-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number892194813102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: