Healthcare Provider Details

I. General information

NPI: 1215906532
Provider Name (Legal Business Name): KENNETH MICHAEL SAUNDERS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

510 TILLMAN PL UNIT E
WEST POINT NY
10996
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-3224
  • Fax:
Mailing address:
  • Phone: 845-926-5572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number562064-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: