Provider Demographics
NPI:1104286285
Name:GOPAUL, SHAMILA (CRNA)
Entity type:Individual
Prefix:
First Name:SHAMILA
Middle Name:
Last Name:GOPAUL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHAMILA
Other - Middle Name:
Other - Last Name:GOPAUL-ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PROVIDER ENROLLMENT 41 MALL ROAD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8085
Mailing Address - Fax:
Practice Address - Street 1:85 HERRICK ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1790
Practice Address - Country:US
Practice Address - Phone:978-816-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129995367500000X
TX874854367500000X
MARN2343495367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300070768Medicaid
IN264431071OtherMEDICARE