Provider Demographics
NPI:1255205803
Name:BOYLE, SHAUN ROBERT (FNP-C)
Entity type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:ROBERT
Last Name:BOYLE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 E ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2312
Mailing Address - Country:US
Mailing Address - Phone:801-349-9908
Mailing Address - Fax:
Practice Address - Street 1:2104 E ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2312
Practice Address - Country:US
Practice Address - Phone:801-349-9908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF07250443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty