Healthcare Provider Details

I. General information

NPI: 1336175553
Provider Name (Legal Business Name): AHMED ALSHAARAWI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD UHS-2
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

18382 SW JANN DR
BEAVERTON OR
97003-3863
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-4910
  • Fax: 503-494-8368
Mailing address:
  • Phone: 617-834-7482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number200660007CRNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: