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NPI Code Detail

MEDICARE: TANISHA R SHEDDEN CSW

MEDICARE:   TANISHA R SHEDDEN  CSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker12819881-3502UT

General Provider Information

NPI Number : 1346098787
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANISHA R SHEDDEN CSW
Provider Business Mailing Address
First Line : 2350 E ROYAL LN
Second Line :
City : SANDY
State : UT
Zip : 84093-6434
Country : US
Telephone Number : 801-637-4461
Fax Number :
Provider Business Practice Location Address
First Line : 59 W 9000 S
Second Line :
City : SANDY
State : UT
Zip : 84070-2008
Country : US
Telephone Number : 801-251-6077
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2024
Last Update Date : 05/09/2024

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Directions to “ TANISHA R SHEDDEN CSW” Practice Location

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