Provider Demographics
NPI:1275893604
Name:SHELLENBERGER, STUART MATTHEW (CRNA)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:MATTHEW
Last Name:SHELLENBERGER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1193
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85502-1193
Mailing Address - Country:US
Mailing Address - Phone:928-402-1217
Mailing Address - Fax:888-321-1535
Practice Address - Street 1:5880 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9447
Practice Address - Country:US
Practice Address - Phone:928-402-1217
Practice Address - Fax:888-321-1535
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA090051367500000X
AZCRNA0851367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered