Healthcare Provider Details

I. General information

NPI: 1396420436
Provider Name (Legal Business Name): SHELLY SAXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 W 6200 S
TAYLORSVILLE UT
84129-3725
US

IV. Provider business mailing address

3725 W 4100 S STE 201
WEST VALLEY CITY UT
84120-5427
US

V. Phone/Fax

Practice location:
  • Phone: 801-963-4360
  • Fax:
Mailing address:
  • Phone: 888-949-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: