Individual
SARAH MARLENE SHADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, NREMT
Contact information
Practice address
2940 S 2300 E, MILLCREEK, UT 84109-1924
(614) 600-4392
Mailing address
2940 S 2300 E, MILLCREEK, UT 84109-1924
(614) 600-4392
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
2023038475
UT
2255A2300X
Athletic Trainer
004879
NY
2255A2300X
Athletic Trainer
12945874-4810
UT
2255A2300X
Athletic Trainer
Primary
AT006365
OH
Other
Enumeration date
04/02/2020
Last updated
03/24/2025
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