Healthcare Provider Details

I. General information

NPI: 1619944915
Provider Name (Legal Business Name): FARKHONDEH SARA SHAMSALI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N PICKAWAY ST
CIRCLEVILLE OH
43113-2409
US

IV. Provider business mailing address

3400 OLENTANGY RIVER RD
COLUMBUS OH
43202-1523
US

V. Phone/Fax

Practice location:
  • Phone: 614-552-0061
  • Fax: 614-552-0168
Mailing address:
  • Phone: 614-552-0061
  • Fax: 614-552-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA-042572
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: