DR. SHANNON L TILLY (NPI# 1093767196) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093767196 |
| Entity Type | Individual |
| Full Name | DR. SHANNON L TILLY |
| Credential | MD |
| Practice Address |
1525 W 2100 S Salt Lake City UT 84119-1401 |
| Mailing Address |
Po Box 510708 Salt Lake City UT 84151-0708 |
| Practice Telephone | 8012139900 |
| Mailing Telephone | 8015876600 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2012-09-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 54125001205 | UT | Allopathic & Osteopathic Physicians |
| Street Address |
1525 W 2100 S |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84119-1401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285624197 | Leslie Anne Gregersen | Pharmacist | 1525 W 2100 S, Salt Lake City, UT 84119-1401 | 2005-10-24 |
| 1174184758 | Cara Wolf | Nurse Practitioner | 1525 W 2100 S, Salt Lake City, UT 84119-1407 | 2019-06-25 |
| 1891272845 | Megan Whitlock | Social Worker | 1525 W 2100 S, Salt Lake City, UT 84119-1407 | 2018-07-23 |
| 1942718473 | Kristi Leavitt Nichols | Midwife | 1525 W 2100 S, Salt Lake City, UT 84119-1407 | 2018-01-18 |
| 1639697931 | Gilbert Gaertner IIi | Physician Assistant | 1525 W 2100 S, Salt Lake City, UT 84119-1407 | 2017-09-07 |
| 1528589579 | Rebecca Kline Burt | Family Medicine | 1525 W 2100 S, Salt Lake City, UT 84119-1407 | 2017-06-29 |
| 1861932576 | Brooke Diane Mariger Paulsen | Nurse Practitioner | 1525 W 2100 S, Salt Lake City, UT 84119-1407 | 2017-02-28 |
| 1356889703 | Ghaida Al-barzinji | Physician Assistant | 1525 W 2100 S, Salt Lake City, UT 84119-1407 | 2017-02-06 |
| 1184077075 | Bobbi Heaney | Nurse Practitioner | 1525 W 2100 S, Salt Lake City, UT 84119-1407 | 2016-07-15 |
| 1700234655 | Caroline Berry Carlson | Physician Assistant | 1525 W 2100 S, Salt Lake City, UT 84119-1407 | 2016-06-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164981932 | Arches Home Care, Inc. | Non-emergency Medical Transport (VAN) | 1385 W 2200 S Ste 203, West Valley City, UT 84119 | 2019-03-19 |
| 1629591003 | Exemplar Healthcare, Inc. | Hospice Care, Community Based | 1385 W 2200 S Ste 202, West Valley City, UT 84119 | 2017-07-18 |
| 1619358496 | Otto Bock Orthopedic Services LLC | Durable Medical Equipment & Medical Supplies | 2875 S Decker Lake Dr Ste 180, West Valley City, UT 84119 | 2015-06-17 |
| 1821407735 | Nathan William Stobbe | Dentist | 3280 W. 3500 S. Ste 3, West Valley, UT 84119 | 2014-08-05 |
| 1801209028 | Utah Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3148 W 3500 S, West Valley City, UT 84119 | 2014-06-05 |
| 1215347935 | Karl Edward Jennings | Social Worker | 3901 S David Pl, West Valley City, UT 84119 | 2014-05-02 |
| 1750624672 | Shannon Quinn Dunlop | Registered Nurse | 2621 S 3270 W, West Valley City, UT 84119 | 2013-03-28 |
| 1215273529 | Holly H Tanski | Counselor | 5770 S. 1500 W. Bld A, Ihc Wasatch Canyons Campus, Salt Lake City, UT 84119 | 2012-12-14 |
| 1982955860 | Oquirrh Meadows Care and Rehab, Inc | Assisted Living Facility | 2948 So. Redwood Road, West Valley City, UT 84119 | 2012-10-02 |
| 1518235068 | Asjad Kaleem Mohammed | Pharmacist | 2290 S Redwood Road, Olive Pharmacy, Salt Lake City, UT 84119 | 2011-12-12 |
| Find all providers in zip 84119 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144753013 | Jessica Kaplan | Obstetrics & Gynecology | University of Utah University Hospital, 50 N Medical Drive, Salt Lake City, UT 84132-0001 | 2017-04-07 |
| 1326571621 | Kylie Measom Soffe | Obstetrics & Gynecology | Ob Gyn Administration 30 N 1900 E Rm 2b200, Salt Lake City, UT 84132-2101 | 2017-04-04 |
| 1639564016 | Kristen Hansord Lilja | Obstetrics & Gynecology | 82 S 1100 E Ste 305, Salt Lake City, UT 84102-4703 | 2015-04-01 |
| 1194119172 | Irina Cassimatis | Obstetrics & Gynecology | University of Utah Obgyn Dept, 30 N 1900 East. Room 2b200, Salt Lake City, UT 84132-0001 | 2015-03-26 |
| 1033509740 | Kathryn Fay | Obstetrics & Gynecology | 30 N 1900 E Rm 2a200, Salt Lake City, UT 84132-2209 | 2015-02-02 |
| 1932528676 | Aliye Runyan | Obstetrics & Gynecology | 30 North 1900 East 2a200, Dept of Obgyn, Salt Lake City, UT 84132 | 2014-04-09 |
| 1467870295 | Ashley Elizabeth Benson | Obstetrics & Gynecology | 30 N 9100 E, Room 2b200, Salt Lake City, UT 84132-0001 | 2014-03-29 |
| 1386088706 | Michelle Lynne Precourt Debbink | Obstetrics & Gynecology | 30 N 1900 E # 2a200, Salt Lake City, UT 84132-5000 | 2013-04-29 |
| 1427300938 | Nathan R Blue | Obstetrics & Gynecology | 30 N 1900 E # 2b200, Salt Lake City, UT 84132 | 2012-10-08 |
| 1417216516 | Robert Lee Dood | Obstetrics & Gynecology | University of Utah Health, Dept of Obgyn, 30 N 1900 E, Rm 2b200, Salt Lake City, UT 84132 | 2012-05-09 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84119 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.