Individual provider Active NPI

Shanelle Marie Smith, NP

  • Nurse Practitioner
  • Malone, NY
National Provider Identifier
1083499438
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
311418 Issued in NY
Practice address
133 Park St
Cardiology Department
Malone, NY 12953-1244
Phone
(518) 481-2545
NPI assigned
Aug 25, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 311418 NY Primary

Addresses

Primary practice location

133 Park St
Cardiology Department
Malone, NY 12953-1244

Mailing address

133 Park St
Malone, NY 12953-1244
Phone (518) 481-2545

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231019002300 NY Practitioner - Nurse Practitioner 2062868599 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alice Hyde Medical Center Nurse Practitioner CurrentSince Sep 25, 2023 Accepting new patients
Champlain Valley Physicians Hospital Medical Center Nurse Practitioner CurrentSince Sep 7, 2023 Accepting new patients
Alice Hyde Medical Center Current Accepting new patients
Alice Hyde Medical Center Past Accepting new patients

Locations

969 State Route 11
Moira, NY 12957
Phone (518) 529-7847

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

Interoperability endpoints

  • Direct secure messaging: ssmith533214@direct.uvmhealth.org

Organizations & group practices 4

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": "1692921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1083499438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 PARK ST",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "129531244",
            "telephone_number": "518-481-2545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 PARK ST",
            "address_2": "CARDIOLOGY DEPARTMENT",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "129531244",
            "telephone_number": "518-481-2545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SHANELLE",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-25",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "311418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Malone, NY

Sources for this page

Verify at the official NPI Registry.