Provider Demographics
NPI:1598062739
Name:ANDERSON, SHAYLA
Entity Type:Individual
Prefix:MS
First Name:SHAYLA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220214
Mailing Address - Street 2:
Mailing Address - City:CENTERFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84622-0214
Mailing Address - Country:US
Mailing Address - Phone:435-528-7849
Mailing Address - Fax:435-283-5387
Practice Address - Street 1:390 W 1ST N
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-2131
Practice Address - Country:US
Practice Address - Phone:435-283-4065
Practice Address - Fax:435-283-5387
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health