Healthcare Provider Details

I. General information

NPI: 1275348807
Provider Name (Legal Business Name): MOONLIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 S HIGHLAND DR # 4025
HOLLADAY UT
84121-2125
US

IV. Provider business mailing address

6211 S HIGHLAND DR # 4025
HOLLADAY UT
84121-2125
US

V. Phone/Fax

Practice location:
  • Phone: 385-246-2522
  • Fax: 801-581-5604
Mailing address:
  • Phone: 385-246-2522
  • Fax: 801-581-5604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER RUFUS SWEENEY
Title or Position: RESIDENT PSYCHIATRIST
Credential: MD
Phone: 801-581-7951