Individual provider Active NPI

Shahana Ali, PA-C

  • Physician Assistant
  • Ocoee, FL
National Provider Identifier
1003115296
Registry record updated May 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
014664-1 Issued in NY
Practice address
10959 W Colonial Dr
Ocoee, FL 34761-2944
Phone
(407) 554-4590
NPI assigned
Mar 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 014664-1 NY Primary

Addresses

Primary practice location

10959 W Colonial Dr
Ocoee, FL 34761-2944

Mailing address

10959 W Colonial Dr
Ocoee, FL 34761-2944
Phone (407) 554-4590

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110620000306 NY Practitioner - Physician Assistant 1456539550 Reassigns benefits to 3 organizations
I20200529000132 FL Practitioner - Physician Assistant 1456539550 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
014664-1NYMDPediatric Occupational Therapist

Practice roles (3 of 8)

OrganizationSpecialtyStatusNew patients
City Medical of Upper East Side, PLLC CurrentSince Oct 16, 2016 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince Oct 16, 2016 Accepting new patients
Fpa Hospital Based CurrentSince Aug 1, 2015 Accepting new patients

Locations

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

336 E 86th St
New York, NY 10028
Phone (212) 772-3627

Networks

  • Freedom Health HMO Network
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590105600000",
    "number": "1003115296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10959 W COLONIAL DR",
            "city": "OCOEE",
            "state": "FL",
            "postal_code": "347612944",
            "telephone_number": "407-554-4590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10959 W COLONIAL DR",
            "city": "OCOEE",
            "state": "FL",
            "postal_code": "347612944",
            "telephone_number": "407-554-4590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALI",
        "first_name": "SHAHANA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-28",
        "last_updated": "2020-05-22",
        "certification_date": "2020-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014664-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocoee, FL

Sources for this page

Verify at the official NPI Registry.