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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MR. SHANE MICHAEL RUDOLPH CRNP
NPI 1922696244
Surgery - Vascular Surgery in Philadelphia, PA

Active since January 03, 2021
3509 N BROAD ST, PHILADELPHIA, PA 19140(215) 707-8484(215) 707-5901 Get Directions Write a Review

NPPES record last updated: September 22, 2026. Verified against the NPPES registry weekly; last sync: October 11, 2026.

Record update history: Sep 22, 2026, Jan 3, 2021 (2 updates tracked since 2021).

About Mr. Shane Michael Rudolph Crnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. SHANE MICHAEL RUDOLPH CRNP (NPI 1922696244) is an individual vascular surgery provider in Philadelphia, Pennsylvania, licensed in Pennsylvania (SP023007) and active in the NPI registry since January 2021.

NPPES Registry Identity

NPI1922696244
Entity TypeIndividualMale
Primary Taxonomy2086S0129X
Provider Legal NameMR. SHANE MICHAEL RUDOLPHCredential: CRNP
Location Address3509 N BROAD STPhiladelphia, PA 19140-4105
Mailing Address3509 N Broad StPhiladelphia, PA 19140-4105 · (215) 707-3911
Phone(215) 707-8484
Fax(215) 707-5901
Sole ProprietorYes
Enumeration DateJanuary 3, 2021
Last NPPES UpdateSeptember 22, 20262 updates tracked since enumeration
NPPES CertifiedSeptember 22, 2026
✔ NPI 1922696244 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Vascular SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0129X
License✔ Licensed in PA · SP023007
Definition
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
3509 N BROAD ST, Philadelphia, PA 19140
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KEWAL KRISHAN MD
Thoracic Surgery (Cardiothoracic Vascular Surgery)
3509 N BROAD ST
PHILADELPHIA, PA 19140
Philadelphia County (215) 707-8484
KURT KUNZ M.D.
Internal Medicine
3509 N BROAD ST, SUITE 226
PHILADELPHIA, PA 19140
Philadelphia County (267) 512-4313
MEGHANA ASHOK PATIL
Internal Medicine (Cardiovascular Disease)
3509 N BROAD ST
PHILADELPHIA, PA 19140
Philadelphia County (215) 707-8484
TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Psychiatry & Neurology (Neurology)
3509 N BROAD ST, FL 6 EAST TUCMC
PHILADELPHIA, PA 19140
Philadelphia County (215) 707-6613
ROSHANI NARENDRAKUMAR PATEL PA-C
Physician Assistant
3509 N BROAD ST
PHILADELPHIA, PA 19140
Philadelphia County (215) 707-8484
DR. CHRISTOPHER WILLIAM AHMED MD
Ophthalmology
3509 N BROAD ST
PHILADELPHIA, PA 19140
Philadelphia County (800) 836-7536
RICHARD TIM LACHMAN MD
Psychiatry & Neurology (Neurology)
3509 N BROAD ST
PHILADELPHIA, PA 19140
Philadelphia County (215) 707-3040
TEMPLE FACULTY PRACTICE PLAN, INC
Otolaryngology
3509 N BROAD ST
PHILADELPHIA, PA 19140
Philadelphia County (215) 707-3663

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shane Rudolph's NPI number?

The NPI number for Shane Rudolph is 1922696244. It was assigned to this individual provider in the NPPES registry on January 3, 2021.

Where is Shane Rudolph located?

Shane Rudolph practices at 3509 N Broad St, Philadelphia, PA 19140. The listed phone number is (215) 707-8484.

What is Shane Rudolph's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Vascular Surgery, with taxonomy code 2086S0129X.

When was this NPI record last updated?

The NPPES record for Shane Rudolph was last updated on September 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 27 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.