Provider Demographics
NPI:1275066060
Name:BURCH, SHAYNA TOVA PURCELL (MS)
Entity type:Individual
Prefix:MRS
First Name:SHAYNA
Middle Name:TOVA PURCELL
Last Name:BURCH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:SHAYNA
Other - Middle Name:TOVA
Other - Last Name:PURCELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:500 FOOTHILL DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84148-0001
Mailing Address - Country:US
Mailing Address - Phone:801-582-1565
Mailing Address - Fax:
Practice Address - Street 1:500 FOOTHILL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-8534
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:801-582-0385
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS