ANTONIO SHADE

SALT LAKE CITY, UT
NPI1497518716
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy172V00000X Community Health Worker
(Licence: UT  13752698-3502)
Enumeration Date2024-01-31
Last Update Date2024-01-31
Business Address
ANTONIO SHADE CSW
344 E 100 S
SALT LAKE CITY, UT 84111-1700
Phone number: 801-428-4257
Mailing Address
ANTONIO SHADE CSW
344 E 100 S
SALT LAKE CITY, UT 84111-1700
Phone number: 801-428-4257
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