Healthcare Provider Details

I. General information

NPI: 1851345425
Provider Name (Legal Business Name): SHANNON J SCATURRO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD SUITE D 240 C
MOBILE AL
36608-3709
US

IV. Provider business mailing address

3202 WYNNFIELD CT
MOBILE AL
36695-2539
US

V. Phone/Fax

Practice location:
  • Phone: 251-631-3272
  • Fax:
Mailing address:
  • Phone: 251-510-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-092632
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: