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NPI Code Detail

MEDICARE: SHAWN MICHAEL MOODY CRNP

MEDICARE: SHAWN MICHAEL MOODY CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LN0005XCritical Care Neonatal Nurse PractitionerSP020260PA

General Provider Information

NPI Number : 1710546817
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN MICHAEL MOODY CRNP
Provider Business Mailing Address
First Line : 118 PINE NUT DR
Second Line :
City : EIGHTY FOUR
State : PA
Zip : 15330-2659
Country : US
Telephone Number : 724-941-2157
Fax Number :
Provider Business Practice Location Address
First Line : 4800 FRIENDSHIP AVE
Second Line :
City : PITTSBURGH
State : PA
Zip : 15224-1793
Country : US
Telephone Number : 412-578-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2019
Last Update Date : 06/12/2019

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