Healthcare Provider Details

I. General information

NPI: 1326864877
Provider Name (Legal Business Name): AYA ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11606 NICHOLAS ST
OMAHA NE
68154-4478
US

IV. Provider business mailing address

10513 ROSEWATER PKWY
BENNINGTON NE
68007-8104
US

V. Phone/Fax

Practice location:
  • Phone: 402-493-2020
  • Fax:
Mailing address:
  • Phone: 402-278-2536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: VALERIE SHAW
Title or Position: PRESIDENT
Credential: CRNA
Phone: 402-278-2536