Individual provider Active NPI

Sandra Flodin, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Murray, UT
National Provider Identifier
1790661320
Registry record updated Aug 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
6218966-4405 Issued in UT
Practice address
1935 E Vine St Ste 170
Murray, UT 84121-2197
Phone
(801) 639-9833
Fax
(801) 639-9833
NPI assigned
Aug 11, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 62188966-8900 UT
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 6218966-4405 UT Primary

Addresses

Primary practice location

1935 E Vine St Ste 170
Murray, UT 84121-2197

Mailing address

1935 E Vine St Ste 179
Murray, UT 84121-2192
Phone (801) 639-9833

Other practice location 1

9164 S Maison Dr
Sandy, UT 84093-2434
Phone (801) 597-2413

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260420001805 UT Practitioner - Nurse Practitioner 1557837291 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1935 E Vine St
Suite 170
Murray, UT 84121-2197
Phone (201) 488-5161

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
62188966-8900UTMDPsychiatric/Mental Health Nurse Practitioner
6218966-4405UTMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
SL-Center of Revitalizing Psychiatry LLC CurrentSince Mar 31, 2026 Accepting new patients

Locations

1935 E Vine St
Ste 170
Murray, UT 84121
Phone (201) 488-5161

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1754870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788134400000",
    "number": "1790661320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1935 E VINE ST STE 179",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841212192",
            "telephone_number": "801-639-9833",
            "fax_number": "801-639-9833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 E VINE ST STE 170",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841212197",
            "telephone_number": "801-639-9833",
            "fax_number": "801-639-9833"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9164 S Maison Dr",
            "address_purpose": "LOCATION",
            "city": "Sandy",
            "state": "UT",
            "postal_code": "840932434",
            "country_code": "US",
            "telephone_number": "801-597-2413",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FLODIN",
        "first_name": "SANDRA",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-08-11",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "UT",
            "license": "62188966-8900",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "UT",
            "license": "6218966-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.