Provider Demographics
NPI:1619944915
Name:SHAMSALI, FARKHONDEH SARA (CRNA)
Entity Type:Individual
Prefix:
First Name:FARKHONDEH
Middle Name:SARA
Last Name:SHAMSALI
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 1:3400 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1523
Mailing Address - Country:US
Mailing Address - Phone:614-552-0061
Mailing Address - Fax:614-552-0168
Practice Address - Street 1:600 N PICKAWAY ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-2409
Practice Address - Country:US
Practice Address - Phone:614-552-0061
Practice Address - Fax:614-552-0168
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-06
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA-042572367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2145084Medicaid
OHSH8225095Medicare ID - Type Unspecified