Provider Demographics
NPI:1114432333
Name:MOON, MELISSA SHIGEYO (CNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SHIGEYO
Last Name:MOON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:SHIGEYO
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:495 COOPER RD STE 211
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8736
Mailing Address - Country:US
Mailing Address - Phone:614-882-2581
Mailing Address - Fax:
Practice Address - Street 1:111 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9342
Practice Address - Country:US
Practice Address - Phone:740-965-3061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH421859207R00000X
OH0032127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine