Provider Demographics
NPI:1598765463
Name:SHEPARD, ROSALIE CACANINDIN (CRNAP)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:CACANINDIN
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:CRNAP
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:MAE
Other - Last Name:CACANINDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNAP
Mailing Address - Street 1:1817 CORAL BAY CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2879
Mailing Address - Country:US
Mailing Address - Phone:757-581-1072
Mailing Address - Fax:
Practice Address - Street 1:3000 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5963
Practice Address - Country:US
Practice Address - Phone:757-736-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164751207L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology