Individual provider Active NPI

Julie Hayedeh Shakib, DO

  • Pediatrics Physician
  • Salt Lake City, UT
National Provider Identifier
1912950817
Registry record updated Nov 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
6172064-1204 Issued in UT
Practice address
50 N Medical Dr
Salt Lake City, UT 84132-0001
Phone
(801) 581-2205
Fax
(801) 581-3899
NPI assigned
May 19, 2006
Last updated
Nov 8, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 6172064-1204 UT Primary

Addresses

Primary practice location

50 N Medical Dr
Salt Lake City, UT 84132-0001

Mailing address

PO Box 413021
Peds Admin
Salt Lake City, UT 84141-3021
Phone (801) 213-3900

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jshakib16321@direct.med.utah.edu Direct University of Utah

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150422000724 UT Practitioner - Pediatric Medicine 2668790759 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Pediatric Services CurrentSince Aug 4, 2021 Accepting new patients
University of Utah Pediatric Services Pediatrics Current Accepting new patients
University of Utah Pediatric Services CurrentSince Aug 4, 2021 Accepting new patients

Locations

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Interoperability endpoints

  • Direct secure messaging: jshakib16321@direct.med.utah.edu

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1912950817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 413021",
            "address_2": "PEDS ADMIN",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841413021",
            "telephone_number": "801-213-3900",
            "fax_number": "801-581-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 N MEDICAL DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-2205",
            "fax_number": "801-581-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAKIB",
        "first_name": "JULIE",
        "middle_name": "HAYEDEH",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "6172064-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jshakib16321@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.