Individual
SANDRA D SHELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3911 HIGHWAY 17 # B, MURRELLS INLET, SC 29576-5014
(843) 651-8211
Mailing address
4509 WOODLAND ST, NORTH MYRTLE BEACH, SC 29582-5244
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
18465
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204185222
BCBS OF SC
SC
05
—
AN0060
—
SC
01
—
DE5998
RR MEDICARE
SC
05
—
GP4376
—
SC
01
—
P00395317
RR MEDICARE
SC
Enumeration date
12/18/2006
Last updated
05/15/2008
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