Healthcare Provider Details

I. General information

NPI: 1639686876
Provider Name (Legal Business Name): TRESSIE SHEKINAS PERRY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/17/2026
Certification Date: 01/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 OLD COUNTRY RD
PLAINVIEW NY
11803-4910
US

IV. Provider business mailing address

3434-135 KILDAIRE FARM RD #797
CARY NC
27518-6705
US

V. Phone/Fax

Practice location:
  • Phone: 516-898-7299
  • Fax: 516-898-7301
Mailing address:
  • Phone: 502-298-7771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number118725
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number923339
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number923339
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number302365
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001229027
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: