Individual
GANNA SHESTAKOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D. PH.D.
Contact information
Practice address
15 N MEDICAL DR STE 1100, SALT LAKE CITY, UT 84112-1100
(801) 583-2787
Mailing address
15 N MEDICAL DR STE 1100, SALT LAKE CITY, UT 84112-1100
(801) 583-2787
Taxonomy
Speciality
Code
Description
License number
State
207ZH0000X
Hematology (Pathology) Physician
Primary
12256633-1205
UT
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
12256633-1205
UT
Other
Enumeration date
05/04/2016
Last updated
07/08/2022
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