Healthcare Provider Details

I. General information

NPI: 1336790153
Provider Name (Legal Business Name): MATTHEW DEAN SHEFFLER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 S BLOOMINGTON ST
GREENCASTLE IN
46135-2212
US

IV. Provider business mailing address

4987 S COUNTY ROAD 325 W
GREENCASTLE IN
46135-8228
US

V. Phone/Fax

Practice location:
  • Phone: 765-301-7300
  • Fax:
Mailing address:
  • Phone: 765-720-9025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number122579
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: