Provider Demographics
NPI:1285802678
Name:SHAH, JENNY KUNVARJI (CRNA APN)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:KUNVARJI
Last Name:SHAH
Suffix:
Gender:F
Credentials:CRNA APN
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Mailing Address - Street 1:802 W TRAILCREEK DR
Mailing Address - Street 2:COSMETIC SURGERY CARE
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1862
Mailing Address - Country:US
Mailing Address - Phone:309-692-3630
Mailing Address - Fax:309-692-3790
Practice Address - Street 1:802 W TRAILCREEK DR
Practice Address - Street 2:COSMETIC SURGERY CARE
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1862
Practice Address - Country:US
Practice Address - Phone:309-692-3630
Practice Address - Fax:309-692-3790
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered