Active NPI
Shanae Correa
- Optician
- Kingston, NY
National Provider Identifier
1033802145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 009769-01
- Practice address
- 601 Frank Sottile Blvd
Kingston, NY 12401-1550 - Phone
- (845) 336-2058
- Fax
- (845) 336-2304
- NPI assigned
- Jun 2, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 009769-01 | NY | Primary |
Addresses
Primary practice location
601 Frank Sottile Blvd
Kingston, NY 12401-1550
Mailing address
2954 State Route 32
Kingston, NY 12401-8654
Phone (845) 913-6780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009769-01 | NY | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685664000000",
"number": "1033802145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2954 STATE ROUTE 32",
"city": "KINGSTON",
"state": "NY",
"postal_code": "124018654",
"telephone_number": "845-913-6780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 FRANK SOTTILE BLVD",
"city": "KINGSTON",
"state": "NY",
"postal_code": "124011550",
"telephone_number": "845-336-2058",
"fax_number": "845-336-2304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORREA",
"first_name": "SHANAE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-02",
"last_updated": "2023-06-02",
"certification_date": "2023-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NY",
"license": "009769-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingston, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.