Provider Demographics
NPI:1316179831
Name:MORAN, CARLLYNE A (CRNA)
Entity Type:Individual
Prefix:
First Name:CARLLYNE
Middle Name:A
Last Name:MORAN
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Gender:F
Credentials:CRNA
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Mailing Address - Street 1:11781 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 550
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3309
Mailing Address - Country:US
Mailing Address - Phone:571-777-5102
Mailing Address - Fax:703-563-6256
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-493-2844
Practice Address - Fax:703-563-6256
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2016-02-02
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Provider Licenses
StateLicense IDTaxonomies
NY548599207L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology