Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

MS. Shannon Dominique Moultry, LPN

Individual provider Licensed Practical Nurse · NPI 1780502179

MS. Shannon Dominique Moultry, LPN is a Licensed Practical Nurse in Cleveland, Ohio. Practices as a sole proprietor. Licensed in Ohio.

Licensed in
OH
In the registry since
2026
What do these letters mean?
LPN — Licensed Practical Nurse
A licensed nurse who works under the direction of an RN or physician.

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Practice location Address checks out

13003 Hlavin Ave
Cleveland, OH 44105-6313
Phone: (216) 387-8335
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Licensed Practical Nurse (primary) Taxonomy 164W00000X · Licence 189339 (OH)

Record details

NPI number1780502179
Entity typeIndividual (Type 1)
GenderFemale
Credentials LPN
Sole proprietorYes
NPI enumeratedJuly 6, 2026
Last updated in NPPESJuly 6, 2026
Certification dateJuly 6, 2026

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