Individual provider Active NPI

Shauna Marie Roloff, NPP

  • Psychiatric/Mental Health Nurse Practitioner
  • Schenectady, NY
National Provider Identifier
1093489833
Registry record updated Jul 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
403601 Issued in NY
Practice address
146 Barrett St Ste 2
Schenectady, NY 12305-2004
Phone
(518) 952-9290
NPI assigned
Aug 5, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 403601 NY Primary

Addresses

Primary practice location

146 Barrett St Ste 2
Schenectady, NY 12305-2004

Mailing address

625 Fellows Ave
Syracuse, NY 13210-3107
Phone (678) 662-4247

Other practice location 1

750 E Adams St
Syracuse, NY 13210-2306
Phone (315) 464-9860

Other practice location 2

719 Harrison St
Syracuse, NY 13210-2695
Phone (315) 464-3265

Other identifiers 1

IdentifierTypeStateIssuer
06772370MedicaidNY

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
I20210902001679 NY Practitioner - Nurse Practitioner 0749686574 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
403601NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Allied Wellness Collective, Ipa, LLC CurrentSince Feb 21, 2026 Accepting new patients
St Joseph'S Hospital Health Center CurrentSince Sep 13, 2021 Accepting new patients
St Josephs Hospital Health Center CurrentSince Sep 13, 2021 Accepting new patients
Southgate Marriage & Family Therapy, PLLC CurrentSince Aug 3, 2025 Accepting new patients
Psychiatry Faculty Practice, Inc. CurrentSince Feb 9, 2023 Accepting new patients

Locations

188 S 3rd St
Fulton, NY 13069
Phone (315) 207-5435

146 Barrett St
Ste 2
Schenectady, NY 12305
Phone (518) 516-1080

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

742 James St
Syracuse, NY 13203
Phone (315) 703-2700

742 James St
Ste 201
Syracuse, NY 13203
Phone (315) 703-2700

301 Prospect Ave
Ste 706
Syracuse, NY 13203
Phone (315) 703-5200

713 Harrison St
Bldg 3
Syracuse, NY 13210
Phone (315) 464-3265

719 Harrison St
Syracuse, NY 13210
Phone (315) 464-3265

Interoperability endpoints

  • Direct secure messaging: sroloff138245@direct.upstate.edu

Organizations & group practices 5

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": "1628121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1093489833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 FELLOWS AVE",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132103107",
            "telephone_number": "678-662-4247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 BARRETT ST STE 2",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123052004",
            "telephone_number": "518-952-9290"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 E Adams St",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132102306",
            "country_code": "US",
            "telephone_number": "315-464-9860",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "719 Harrison St",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132102695",
            "country_code": "US",
            "telephone_number": "315-464-3265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROLOFF",
        "first_name": "SHAUNA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "NPP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-05",
        "last_updated": "2025-07-29",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "403601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06772370",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schenectady, NY

Sources for this page

Verify at the official NPI Registry.