Healthcare Provider Details

I. General information

NPI: 1336468453
Provider Name (Legal Business Name): MARY SHAILA NAGANOOLIL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 WESTON RD
WESTON FL
33331-3602
US

IV. Provider business mailing address

3100 WESTON RD
WESTON FL
33331-3602
US

V. Phone/Fax

Practice location:
  • Phone: 954-689-5228
  • Fax:
Mailing address:
  • Phone: 954-689-5228
  • Fax: 954-659-5047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9224879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: