Healthcare Provider Details

I. General information

NPI: 1912981937
Provider Name (Legal Business Name): SHEILA JANICE PEDDREW CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CENTURY BLVD CHEVY CHASE ANESTHESIA LLC SUITE 480
GERMANTOWN MD
20874-1113
US

IV. Provider business mailing address

8013 REMINGTON AVE
WINDSOR MILL MD
21244-2153
US

V. Phone/Fax

Practice location:
  • Phone: 301-515-4222
  • Fax: 301-515-4153
Mailing address:
  • Phone: 410-336-4335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR039580
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: