Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 11745596-1205 | UT |
Y | 208000000X | Pediatrician | 11745596-1205 | UT |
NPI | 1861806523 |
---|---|
Provider Name | Dr. Brian Shayota |
First Address | East Orange, NJ 07018-2612 |
Second Address | Salt Lake City, UT 84108-1287 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2014 |
Last Update Date | 10/11/2021 |