Provider Demographics
NPI:1003654831
Name:HADEAN, SHAY MALISSA (NP)
Entity type:Individual
Prefix:
First Name:SHAY
Middle Name:MALISSA
Last Name:HADEAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 CRABAPPLE CT
Mailing Address - Street 2:
Mailing Address - City:FRANCIS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-5575
Mailing Address - Country:US
Mailing Address - Phone:435-659-9903
Mailing Address - Fax:
Practice Address - Street 1:869 CRABAPPLE CT
Practice Address - Street 2:
Practice Address - City:FRANCIS
Practice Address - State:UT
Practice Address - Zip Code:84036-5575
Practice Address - Country:US
Practice Address - Phone:435-659-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14055820-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner