Provider Demographics
NPI:1598386294
Name:STONE, SHAHEED MALIK (CRNA)
Entity Type:Individual
Prefix:
First Name:SHAHEED
Middle Name:MALIK
Last Name:STONE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19581 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2135
Mailing Address - Country:US
Mailing Address - Phone:561-346-6715
Mailing Address - Fax:
Practice Address - Street 1:19581 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33469-2135
Practice Address - Country:US
Practice Address - Phone:561-346-6715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013788367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered