Provider Demographics
NPI:1144240862
Name:AMAYA, SHARON MARIE II (CRNA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:AMAYA
Suffix:II
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:HEBERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:10177 STATION WAY APT 127
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6846
Mailing Address - Country:US
Mailing Address - Phone:253-961-8420
Mailing Address - Fax:
Practice Address - Street 1:227 BELLEVUE WAY NE # 188
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5721
Practice Address - Country:US
Practice Address - Phone:888-337-3509
Practice Address - Fax:866-472-1356
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005022072367500000X
COAPN0991606-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1144240862Medicaid