MEDICARE: SHANDA MAXFIELD DNP

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
1	363LF0000X	Family Nurse Practitioner	14105487-4405	UT

General Provider Information

NPI Number	:	1801585393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANDA MAXFIELD DNP

Provider Business Mailing Address
First Line	:	11886 S POULTRY DR
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-6813
Country	:	US
Telephone Number	:	801-913-0316
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 S FASHION BLVD STE 180
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-8135
Country	:	US
Telephone Number	:	12-627-2468
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2023
Last Update Date	:	06/27/2025

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