Provider Demographics
NPI:1790142644
Name:MARTIN, SHEILA MARIE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:MARIE
Other - Last Name:VIBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2757
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20195-0757
Mailing Address - Country:US
Mailing Address - Phone:703-471-0919
Mailing Address - Fax:
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3204
Practice Address - Country:US
Practice Address - Phone:703-471-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-23
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173297363L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner