Healthcare Provider Details

I. General information

NPI: 1730578758
Provider Name (Legal Business Name): SHANNAN LYNNE TREBING CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST # TMP3
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

333 CEDAR ST # TPM3
NEW HAVEN CT
06510-3206
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2802
  • Fax: 203-785-6664
Mailing address:
  • Phone: 203-785-2802
  • Fax: 203-785-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9309827
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9295
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: