Active NPI
Kristina Fedorovna Shalygina, PA-S
- Physician Assistant
- Manchester, NH
National Provider Identifier
1043992704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 64358
- Practice address
- 1260 Elm St
Manchester, NH 03101-1305 - Phone
- (603) 716-8663
- NPI assigned
- Aug 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | 64358 | CA | Primary |
Addresses
Primary practice location
1260 Elm St
Manchester, NH 03101-1305
Mailing address
48 Cascade Cir
Manchester, NH 03103-6905
Phone (160) 371-6866
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64358 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cep America - California | Current | Accepting new patients |
Locations
2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
1141 Rose Ave
Selma, CA 93662
Phone (559) 790-2800
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": "1690934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718928000000",
"number": "1043992704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "48 CASCADE CIR",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031036905",
"telephone_number": "160-371-6866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1260 ELM ST",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031011305",
"telephone_number": "603-716-8663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHALYGINA",
"first_name": "KRISTINA",
"middle_name": "FEDOROVNA",
"credential": "PA-S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-02",
"last_updated": "2024-06-21",
"certification_date": "2024-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "64358",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.