Provider Demographics
NPI:1093783573
Name:PERIARD, SHELLI A (CRNA)
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:A
Last Name:PERIARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 COUNTY ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:NY
Mailing Address - Zip Code:12809-1709
Mailing Address - Country:US
Mailing Address - Phone:813-731-8231
Mailing Address - Fax:
Practice Address - Street 1:4333 COUNTY ROUTE 48
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:NY
Practice Address - Zip Code:12809-1709
Practice Address - Country:US
Practice Address - Phone:813-731-8231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9170527367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307432300Medicaid
FL307432300Medicaid