L Kristin Shadow, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

3282171205 Issued in UT

Practice address

50 N Medical Dr
Salt Lake City, UT 84132-0100

Phone

(801) 581-7951

NPI assigned

Jul 20, 2006

Last updated

Nov 19, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Uhs of Provo Canyon, Inc.

  dba Aspen Grove Behavioral Hospital

  • Psychiatric Hospital
  • Orem, UT
  • NPI 1457617409
  Medicare reassignment NPD
• University of Utah Behavioral Health Services

  dba College of Nursing, Mental Health Services

  • Psychiatry Physician
  • Salt Lake City, UT
  • NPI 1740688613
  Medicare reassignment NPD
• University of Utah Behavioral Health Services

  dba Pain Management Mental Health

  • Pain Medicine Physician
  • Salt Lake City, UT
  • NPI 1629476502
  NPD
• University of Utah Behavioral Health Services

  dba Adult Sports Psychiatry

  • Sports Medicine (Psychiatry & Neurology) Physician
  • Salt Lake City, UT
  • NPI 1740158955
  NPD

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384819200000",
    "number": "1922028497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 413029",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841413029",
            "telephone_number": "801-213-3900"
        },
        {
            "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": "841320100",
            "telephone_number": "801-581-7951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADOW",
        "first_name": "L",
        "middle_name": "KRISTIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2013-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "UT",
            "license": "3282171205",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "328217-1205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sfaba Ut LLC
• Akram M. Shaaban, MBBCH
• Rachel Marie Shackelford, MOTR/L
• Alex H. Shacklette, MD
• Jessica Shade
• Hallie Kendall Shafer
• Andrea Dawn Shaffer
• Robert Matthew Shaffer
• Scott Shaffer
• Stacey Kay Shaffer, APRN

• Child & Adolescent Psychiatry Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Child & Adolescent Psychiatry Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.