Healthcare Provider Details

I. General information

NPI: 1821098930
Provider Name (Legal Business Name): SHANNON D DALE HALL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 COLLEGE ST YALE NEW HAVEN HOSPITAL
NEW HAVEN CT
06511-8962
US

IV. Provider business mailing address

640 URLACHER DR
MURFREESBORO TN
37129-8998
US

V. Phone/Fax

Practice location:
  • Phone: 203-432-2700
  • Fax:
Mailing address:
  • Phone: 615-796-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number071173
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number003790
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number20635
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: