MEDICARE: SHANA ALEXANDER CRABTREE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0214X	Pediatric Pulmonology Physician	0101253851	VA
2	174400000X	Specialist	N6237	TX
3	2080P0214X	Pediatric Pulmonology Physician	2016-02199	NC
4	390200000X	Student in an Organized Health Care Education/Training Program	0116019233	VA

General Provider Information

NPI Number	:	1124221981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANA ALEXANDER CRABTREE MD

Provider Business Mailing Address
First Line	:	100 KIMEL FOREST DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6074
Country	:	US
Telephone Number	:	336-716-0238
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-713-4500
Fax Number	:	336-713-4501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	10/02/2024

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