Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 10742767-1205 | UT |
N | 208600000X | Surgeon | 10742767-1205 | UT |
Y | 208200000X | Surgeon | MD460847 | PA |
Y | 208600000X | Surgeon | MD460847 | PA |
N | 2082S0105X | Plastic Hand Surgeon | 10742767-1205 | UT |
N | 2086S0122X | Plastic and Reconstructive Surgery | 10742767-1205 | UT |
NPI | 1023305018 |
---|---|
Provider Name | Dr. Shaun Douglas Mendenhall |
First Address | Salt Lake City, UT 84132-0002 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 29/11/2021 |