Provider Demographics
NPI:1396077780
Name:SHEA, CAROLINE V (CRNA)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:V
Last Name:SHEA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:VICTORIA
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:3100 SPRING FOREST RD STE 130
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2880
Mailing Address - Country:US
Mailing Address - Phone:888-280-9533
Mailing Address - Fax:919-873-9821
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-3138
Practice Address - Fax:703-433-9248
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168644367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1396077780Medicaid
MD361702500Medicaid
MD361702500Medicaid
VAQ44355AMedicare PIN