Healthcare Provider Details

I. General information

NPI: 1215221817
Provider Name (Legal Business Name): SHELDON MOON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 N 2260 W
HURRICANE UT
84737-2034
US

IV. Provider business mailing address

PO BOX 2205
CEDAR RAPIDS IA
52406-2205
US

V. Phone/Fax

Practice location:
  • Phone: 435-635-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9080
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9097346
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: