Provider Demographics
NPI:1477618692
Name:SHIMANDLE, SHARON A (CRNA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:SHIMANDLE
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 1:6125 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3820
Mailing Address - Country:US
Mailing Address - Phone:440-233-8181
Mailing Address - Fax:440-233-8182
Practice Address - Street 1:1111 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3323
Practice Address - Country:US
Practice Address - Phone:440-233-8181
Practice Address - Fax:440-233-8182
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA06696367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2278048Medicaid
OH2278048Medicaid
OHP45116Medicare UPIN