Healthcare Provider Details

I. General information

NPI: 1659310530
Provider Name (Legal Business Name): MELISSA IVY SHERIDAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. MELISSA IVY KRYANINKO

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E THUNDERBIRD RD SUITE 3
PHOENIX AZ
85022-5306
US

IV. Provider business mailing address

2500 W UTOPIA RD SUITE 100
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 602-674-6220
  • Fax: 602-978-2198
Mailing address:
  • Phone: 623-434-6200
  • Fax: 623-434-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8695
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: