Provider Demographics
NPI:1699104976
Name:SHENKOSKY, SUSAN (CRNA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHENKOSKY
Suffix:
Gender:F
Credentials:CRNA
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Other - Last Name:
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Mailing Address - Street 1:1200 N STATE ST
Mailing Address - Street 2:IPT, ROOM C4E100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1029
Mailing Address - Country:US
Mailing Address - Phone:323-409-4597
Mailing Address - Fax:323-441-8085
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:IPT, ROOM C4E100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1029
Practice Address - Country:US
Practice Address - Phone:323-409-4597
Practice Address - Fax:323-441-8085
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2020-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.0020187367500000X
CA712121367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered