Healthcare Provider Details

I. General information

NPI: 1063142016
Provider Name (Legal Business Name): SHANELLE LINDO CRNA, DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 CHESTERFIELD DR
LAWRENCEVILLE GA
30044-5625
US

IV. Provider business mailing address

623 CHESTERFIELD DR
LAWRENCEVILLE GA
30044-5625
US

V. Phone/Fax

Practice location:
  • Phone: 954-907-0570
  • Fax:
Mailing address:
  • Phone: 954-907-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9379927
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number77793
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number136916
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: