Healthcare Provider Details

I. General information

NPI: 1750276465
Provider Name (Legal Business Name): CHANGHONG CHERRY STEELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 S REDWOOD RD
SLC UT
84104-5112
US

IV. Provider business mailing address

1875 S REDWOOD RD
SALT LAKE CITY UT
84104-5112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-3883
  • Fax:
Mailing address:
  • Phone: 801-359-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6856491-3102
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: