Individual
MR. SHANE LAWRENCE PELANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4135 BOARDMAN CANFIELD RD, SUITE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Mailing address
1044 BELMONT AVE, YOUNGSTOWN, OH 44504-1006
(330) 480-3658
(330) 480-3439
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
COA-12110-NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000761030
ANTHEM BCBS
OH
01
—
12241994
CAQH
—
05
—
3128930
—
OH
01
—
H088220
MEDICARE PTAN
OH
01
—
P01135540
MEDICARE RAILROAD
OH
Enumeration date
01/11/2011
Last updated
02/11/2015
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