Healthcare Provider Details

I. General information

NPI: 1013451962
Provider Name (Legal Business Name): MELISSA ANN WRIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA ANN DAVIS

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

IV. Provider business mailing address

81 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-3599
  • Fax:
Mailing address:
  • Phone: 801-213-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10714522-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number10714522-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: