Provider Demographics
NPI:1285046706
Name:CHATELAIN, SHAUN (DO)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:CHATELAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N 1900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0002
Mailing Address - Country:US
Mailing Address - Phone:801-213-2257
Mailing Address - Fax:435-843-3015
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0002
Practice Address - Country:US
Practice Address - Phone:801-213-2257
Practice Address - Fax:801-585-3884
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007741207RG0300X
AZFC7864223207RG0300X
UTFC1083942207RG0300X
UT10306290-8904207RG0300X
UT10306290-1204207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine