Provider Demographics
NPI:1073747887
Name:DOCTOR, SHANEEN UMAKANT (MD)
Entity Type:Individual
Prefix:
First Name:SHANEEN
Middle Name:UMAKANT
Last Name:DOCTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 FLETCHER CT
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3022
Mailing Address - Country:US
Mailing Address - Phone:503-490-9890
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF UTAH HOSPITAL
Practice Address - Street 2:30 NORTH 1900 EAST
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT39207PE0004X
UT1073747887207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine