Provider Demographics
NPI:1740542752
Name:FLEMING, SHAWN SULLIVAN (CRNA)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:SULLIVAN
Last Name:FLEMING
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 1:4500 MANOR VILLAGE WAY
Mailing Address - Street 2:APT 242
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3654
Mailing Address - Country:US
Mailing Address - Phone:828-850-9646
Mailing Address - Fax:
Practice Address - Street 1:4500 MANOR VILLAGE WAY
Practice Address - Street 2:APT 242
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3654
Practice Address - Country:US
Practice Address - Phone:828-850-9646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC224880163W00000X
SC20022367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse