MEDICARE: MS. MELISSA IVY SHERIDAN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP8695	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659310530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA IVY SHERIDAN ARNP

Provider Business Mailing Address
First Line	:	2500 W UTOPIA RD
Second Line	:	SUITE 100
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4171
Country	:	US
Telephone Number	:	623-434-6200
Fax Number	:	623-434-6164

Provider Business Practice Location Address
First Line	:	750 E THUNDERBIRD RD
Second Line	:	SUITE 3
City	:	PHOENIX
State	:	AZ
Zip	:	85022-5306
Country	:	US
Telephone Number	:	602-674-6220
Fax Number	:	602-978-2198

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	08/30/2016

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