Healthcare Provider Details

I. General information

NPI: 1770826422
Provider Name (Legal Business Name): SHEMNON Z MIYAMOTO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 CREEKSIDE BLVD STE 1
NAPLES FL
34108-1931
US

IV. Provider business mailing address

12930 POSITANO CIR APT. 101
NAPLES FL
34105-4841
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9307982
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: