Healthcare Provider Details

I. General information

NPI: 1609174333
Provider Name (Legal Business Name): SUSAN MARIE SHINGLEDECKER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 WILMINGTON AVE
NEW CASTLE PA
16105-2516
US

IV. Provider business mailing address

1601 MOTOR INN DR SUITE 310
GIRARD OH
44420-2420
US

V. Phone/Fax

Practice location:
  • Phone: 724-656-4092
  • Fax: 724-269-9476
Mailing address:
  • Phone: 724-824-4096
  • Fax: 724-269-9476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN349335L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN276058
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number086375
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: