Provider Demographics
NPI:1194396275
Name:KANSAGRA, SHEENALI PATEL (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHEENALI
Middle Name:PATEL
Last Name:KANSAGRA
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11193 S REDWOOD RD STE 102N
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8208
Mailing Address - Country:US
Mailing Address - Phone:385-438-3255
Mailing Address - Fax:358-900-1234
Practice Address - Street 1:11193 S REDWOOD RD STE 102N
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8208
Practice Address - Country:US
Practice Address - Phone:385-438-3255
Practice Address - Fax:358-900-1234
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114273864405363LP0808X
UT114273868900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health