Provider Demographics
NPI:1205993607
Name:STEELE, SABRINA L (PA-C)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:L
Last Name:STEELE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 S REDWOOD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-6798
Mailing Address - Country:US
Mailing Address - Phone:801-265-2212
Mailing Address - Fax:801-265-0103
Practice Address - Street 1:6321 S REDWOOD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-6798
Practice Address - Country:US
Practice Address - Phone:801-265-2212
Practice Address - Fax:801-265-0103
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT330962-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000060111Medicare PIN
UTQ35196Medicare UPIN