Provider Demographics
NPI:1427030022
Name:HUPP, SHELLEY CROUCH (CRNA)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:CROUCH
Last Name:HUPP
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SOUTHGATE AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2827
Mailing Address - Country:US
Mailing Address - Phone:410-279-2825
Mailing Address - Fax:
Practice Address - Street 1:621 RIDGELY AVE STE 101
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1087
Practice Address - Country:US
Practice Address - Phone:410-224-3636
Practice Address - Fax:410-972-2698
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR159320367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401467700Medicaid
MDG116Medicare ID - Type Unspecified
MDS589Medicare PIN
MDR2993Medicare UPIN
MD596PMedicare PIN