Healthcare Provider Details

I. General information

NPI: 1144217183
Provider Name (Legal Business Name): ELIZABETH J SHELLY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 OLD WEST CHESTER PIKE STE 337
HAVERTOWN PA
19083-2712
US

IV. Provider business mailing address

PO BOX 1250
HAVERTOWN PA
19083-5850
US

V. Phone/Fax

Practice location:
  • Phone: 610-789-8070
  • Fax: 610-789-9937
Mailing address:
  • Phone: 610-789-8076
  • Fax: 610-789-9937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN175261L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: