Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 2752851205 | UT |
Y | 207NP0225X | Pediatric Dermatologist | 2752851205 | UT |
N | 207NS0135X | Procedural Dermatology | 2752851205 | UT |
NPI | 1356426829 |
---|---|
Provider Name | Dr. Sheryll Land Vanderhooft |
First Address | Salt Lake City, UT 84110-3208 |
Second Address | Salt Lake City, UT 84112-8924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000W4615 | (05) | NM |
002087219 | (05) | NV |
003054400 | (05) | ID |
0098209 | (05) | MT |
10025133700 | (05) | NE |
393158 | (05) | AZ |
870468377001 | (05) | UT |
F75311 | (02) | UT |
MD391UT | (05) | AK |