MEDICARE: SHANNON SEIFERT CRNA

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	367500000X	Certified Registered Nurse Anesthetist	R145654	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	454MK569	OTHER	MD	TRAILBLAZER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396742946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON SEIFERT CRNA

Provider Business Mailing Address
First Line	:	7108 SANDY SPRING RD
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-5310
Country	:	US
Telephone Number	:	240-603-7987
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E UNIVERSITY PKWY
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-2829
Country	:	US
Telephone Number	:	410-455-2300
Fax Number	:

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	01/22/2019

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Directions to “ SHANNON SEIFERT CRNA” Practice Location

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