Healthcare Provider Details

I. General information

NPI: 1285988865
Provider Name (Legal Business Name): SHANE AARON LEININGER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 W CROSSROADS BLVD
SARATOGA SPRINGS UT
84045-5506
US

IV. Provider business mailing address

354 W CROSSROADS BLVD
SARATOGA SPRINGS UT
84045-5506
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-5585
  • Fax:
Mailing address:
  • Phone: 801-714-5585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8516744-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA1386
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: