Individual provider Active NPI

Shauna Thariath, MD

  • Pediatrics Physician
  • Syracuse, NY
National Provider Identifier
1003377979
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
317553 Issued in NY
Practice address
725 East Adams St
4TH FL
Syracuse, NY 13210
Phone
(315) 464-5831
Fax
(315) 464-2030
NPI assigned
Mar 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 317553 NY Primary

Addresses

Primary practice location

725 East Adams St
4TH FL
Syracuse, NY 13210

Mailing address

725 East Adams St
4TH FL
Syracuse, NY 13210
Phone (315) 464-5831

Other practice location 1

1127 University Blvd NE
Albuquerque, NM 87102-1740
Phone (505) 272-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220708001950 NY Practitioner - Pediatric Medicine 2264760644 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Upstate Emergency Medicine, Inc CurrentSince Jul 1, 2023 Accepting new patients
Pediatric Service Group Pediatrics CurrentSince Jul 1, 2022 Accepting new patients

Locations

4900 Broad Rd
Syracuse, NY 13215
Phone (315) 492-5011

725 E Adams St
Fl 4
Syracuse, NY 13210
Phone (315) 464-4686

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

90 Presidential Plz
Fl 3
Syracuse, NY 13202
Phone (315) 464-4357

Interoperability endpoints

  • Direct secure messaging: sthariath130912@direct.upstate.edu

Organizations & group practices 2

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": "1553472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1003377979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 EAST ADAMS ST",
            "address_2": "4TH FL",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13210",
            "telephone_number": "315-464-5831",
            "fax_number": "315-464-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 EAST ADAMS ST",
            "address_2": "4TH FL",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13210",
            "telephone_number": "315-464-5831",
            "fax_number": "315-464-2030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1127 University Blvd NE",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871021740",
            "country_code": "US",
            "telephone_number": "505-272-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THARIATH",
        "first_name": "SHAUNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-25",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "317553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.