Healthcare Provider Details

I. General information

NPI: 1598223422
Provider Name (Legal Business Name): AMANDA BETH SHEHADEH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA BETH HAUSER

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

81 GENTIAN AVE
PROVIDENCE RI
02908-1107
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-5000
  • Fax:
Mailing address:
  • Phone: 401-323-3182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2289940
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN02869
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: