Provider Demographics
NPI:1669290144
Name:SIMPSON, SHAYLA RENEE
Entity type:Individual
Prefix:
First Name:SHAYLA
Middle Name:RENEE
Last Name:SIMPSON
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 1:1385 S STATE ST FL 4
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5584
Mailing Address - Country:US
Mailing Address - Phone:385-460-7759
Mailing Address - Fax:
Practice Address - Street 1:1467 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2145
Practice Address - Country:US
Practice Address - Phone:385-460-7759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local