Provider Demographics
NPI:1174633408
Name:WHATCOTT-SCLAFANI, SHAUNA (PA)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:WHATCOTT-SCLAFANI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:
Other - Last Name:WHATCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:1175 E 50 S
Practice Address - Street 2:STE 251
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2845
Practice Address - Country:US
Practice Address - Phone:801-492-2815
Practice Address - Fax:801-429-0191
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3638231206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP18126Medicare UPIN