Individual
MICHAEL SHELEKHOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
14425 S BITTERBRUSH LN, DRAPER, UT 84020
(801) 576-7000
Mailing address
4076 S 1610 E, MILLCREEK, UT 84124-1521
(801) 669-0060
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041375125
IL
163W00000X
Registered Nurse
6381032-3102
UT
363L00000X
Nurse Practitioner
209.017270
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
6381032-4405
UT
Other
Enumeration date
01/25/2018
Last updated
11/18/2018
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