Shannon Dominique Moultry, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

189339 Issued in OH

Practice address

13003 Hlavin Ave
Cleveland, OH 44105-6313

Phone

(216) 387-8335

NPI assigned

Jul 6, 2026

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1783296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783296000000",
    "number": "1780502179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13003 HLAVIN AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441056313",
            "telephone_number": "216-387-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13003 HLAVIN AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441056313",
            "telephone_number": "216-387-8335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULTRY",
        "first_name": "SHANNON",
        "middle_name": "DOMINIQUE",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-07-06",
        "last_updated": "2026-07-06",
        "certification_date": "2026-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "189339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robin Mouck Chriszt, CNP
• Rohit Moudgil, MD/PHD
• Maribelle Moufawad, MD
• Douglas Edward Moul, M.D., M.P.H.
• Ebony Nicole Moultry, STNA
• Mount Horeb Homecare LLC
• William Mount, LPC
• Mountaineer Home Healthcare Agency
• Mountaineer Home Healthcare Agency, LLC
• Annika Mounts, MD

• Licensed Practical Nurse in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.