Healthcare Provider Details

I. General information

NPI: 1124982541
Provider Name (Legal Business Name): SHANE CHENEY RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2267 N DAPPLE DR
TOOELE UT
84074-4409
US

IV. Provider business mailing address

2267 N DAPPLE DR
TOOELE UT
84074-4409
US

V. Phone/Fax

Practice location:
  • Phone: 801-597-7842
  • Fax:
Mailing address:
  • Phone: 801-597-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number5570379-5701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: