Provider Demographics
NPI:1821077942
Name:SOPKO, SHIRLEY MACK (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:MACK
Last Name:SOPKO
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 1:2606 CREEK RIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-7455
Mailing Address - Country:US
Mailing Address - Phone:919-932-1365
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:UNC HOSPITALS
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-966-5136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC140874367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8050562Medicaid
NC8050562Medicaid