Provider Demographics
NPI:1912948852
Name:RUFF, SHELLY R (CRNA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:R
Last Name:RUFF
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8310 N CAPITAL OF TEXAS HWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1011
Mailing Address - Country:US
Mailing Address - Phone:512-342-2382
Mailing Address - Fax:512-342-2878
Practice Address - Street 1:8310 N CAPITAL OF TEXAS HWY
Practice Address - Street 2:SUITE 350
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1011
Practice Address - Country:US
Practice Address - Phone:512-342-2382
Practice Address - Fax:512-342-2878
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX721202163W00000X
TXAP114468367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110847401Medicaid
TX8G5144Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE