Healthcare Provider Details

I. General information

NPI: 1689801383
Provider Name (Legal Business Name): SHANE JOSEPH TROSCLAIR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 HUFFMAN MILL RD
BURLINGTON NC
27215-8700
US

IV. Provider business mailing address

3100 SPRING FOREST RD SUITE 130
RALEIGH NC
27616-2880
US

V. Phone/Fax

Practice location:
  • Phone: 336-538-7000
  • Fax:
Mailing address:
  • Phone: 919-882-0795
  • Fax: 919-873-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3006972
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number82125
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: