Healthcare Provider Details

I. General information

NPI: 1790848364
Provider Name (Legal Business Name): SANDRA D SHELLEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 HIGHWAY 17 # B
MURRELLS INLET SC
29576-5014
US

IV. Provider business mailing address

4509 WOODLAND ST
NORTH MYRTLE BEACH SC
29582-5244
US

V. Phone/Fax

Practice location:
  • Phone: 843-651-8211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number18465
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: