Active NPI
Aketa Shallow
- Specialist
- Brooklyn, NY
National Provider Identifier
1093383978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- 137 E 35TH St
Brooklyn, NY 11203-2718 - Phone
- (917) 476-9308
- NPI assigned
- Jun 16, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
137 E 35TH St
Brooklyn, NY 11203-2718
Mailing address
7000 Austin St Ste 200
Forest Hills, NY 11375-4739
Phone (917) 476-9308
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 961167397 | Other | NY | DRIVERS LICENSE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623801600000",
"number": "1093383978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7000 AUSTIN ST STE 200",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113754739",
"telephone_number": "917-476-9308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "137 E 35TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112032718",
"telephone_number": "917-476-9308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHALLOW",
"first_name": "AKETA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-16",
"last_updated": "2021-06-16",
"certification_date": "2021-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVERS LICENSE",
"identifier": "961167397",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.