Provider Demographics
NPI:1558917906
Name:DYE, SHAYLENE (ATC)
Entity Type:Individual
Prefix:
First Name:SHAYLENE
Middle Name:
Last Name:DYE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 N MONTROSE LN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3278
Mailing Address - Country:US
Mailing Address - Phone:970-629-1417
Mailing Address - Fax:
Practice Address - Street 1:1157 N 300 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6124
Practice Address - Country:US
Practice Address - Phone:801-351-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8510224-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer