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: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 S 1100 E
SALT LAKE CITY UT
84105-2421
US

IV. Provider business mailing address

1336 S 1100 E
SALT LAKE CITY UT
84105-2421
US

V. Phone/Fax

Practice location:
  • Phone: 385-246-2522
  • Fax: 801-810-1343
Mailing address:
  • Phone: 385-246-2522
  • Fax: 801-810-1343

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