Provider Demographics
NPI:1124221981
Name:CRABTREE, SHANA ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:ALEXANDER
Last Name:CRABTREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-2314
Mailing Address - Country:US
Mailing Address - Phone:703-850-9008
Mailing Address - Fax:
Practice Address - Street 1:WAKE FOREST BAPTIST HEALTH
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:703-850-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012538512080P0214X
VA0116019233390200000X
TXN6237174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No174400000XOther Service ProvidersSpecialist