Provider Demographics
NPI:1821426081
Name:RUDI, SHAUN MATTHEW (CRNA)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:MATTHEW
Last Name:RUDI
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 1:1961 ZIENTARA LOOP
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-5342
Mailing Address - Country:US
Mailing Address - Phone:803-530-5466
Mailing Address - Fax:
Practice Address - Street 1:1961 ZIENTARA LOOP
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-5342
Practice Address - Country:US
Practice Address - Phone:803-530-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000031578367500000X
MARN2324800367500000X
SC18843367500000X
SC201365390200000X
FLAPRN9446750367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program