Individual
SHAMILA GOPAUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
85 HERRICK ST, BEVERLY, MA 01915-1790
(978) 816-3700
Mailing address
PROVIDER ENROLLMENT 41 MALL ROAD, BURLINGTON, MA 01805-0001
(781) 744-8085
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
874854
TX
367500000X
Certified Registered Nurse Anesthetist
AP129995
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
RN2343495
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264431071
MEDICARE
IN
05
—
300070768
—
IN
Enumeration date
03/02/2016
Last updated
04/03/2024
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