Provider Demographics
NPI:1376127266
Name:SUA, SHIELA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:SHIELA
Middle Name:
Last Name:SUA
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 1:6614 BLUE DIAMOND RD UNIT 1213
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7324
Mailing Address - Country:US
Mailing Address - Phone:404-992-9831
Mailing Address - Fax:
Practice Address - Street 1:1462 CALLE PROF. AUGUSTO RODRIGUEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00909
Practice Address - Country:UM
Practice Address - Phone:787-641-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV134953367500000X
FLAPRN11021389367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered