Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 1073747887 | UT |
Y | 207PE0004X | Emergency Medical Services | 39 | UT |
NPI | 1073747887 |
---|---|
Provider Name | Shaneen Umakant Doctor |
First Address | Salt Lake City, UT 84102-3022 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2009 |
Last Update Date | 23/07/2012 |