Provider Demographics
NPI:1659310530
Name:SHERIDAN, MELISSA IVY (ARNP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:IVY
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:IVY
Other - Last Name:KRYANINKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:623-434-6200
Mailing Address - Fax:623-434-6164
Practice Address - Street 1:750 E THUNDERBIRD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5306
Practice Address - Country:US
Practice Address - Phone:602-674-6220
Practice Address - Fax:602-978-2198
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307119700Medicaid