Healthcare Provider Details

I. General information

NPI: 1518073220
Provider Name (Legal Business Name): SHRUTI B. SANGHVI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E 400 N, STE. 110
VINEYARD UT
84058-8405
US

IV. Provider business mailing address

PO BOX 912042
ST GEORGE UT
84791-2042
US

V. Phone/Fax

Practice location:
  • Phone: 385-666-9600
  • Fax: 385-666-9601
Mailing address:
  • Phone: 435-215-0228
  • Fax: 435-986-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number6234413-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: