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General NPI Number Information
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NPI Number | 1942870555
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Entity Type | Individual
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Provider Name | SHEAU FAN LAM DNP, CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/26/2021
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 550 PEACHTREE ST NE
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City | ATLANTA
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State | GA
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Zip | 30308-2212
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Country | US
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Telephone | 404-686-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 4379 OLD BAYOU TRL
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City | DESTIN
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State | FL
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Zip | 32541-3443
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Country | US
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Telephone | 251-802-1128
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP61442362
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | GAA-CRNA002787
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License Number State | GA
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