Individual provider Active NPI

Christina Shamrock, PA

  • Surgical Physician Assistant
  • New York, NY
National Provider Identifier
1104587039
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
028024 Issued in NY
Practice address
635 Madison Ave Ste 1402E
New York, NY 10022-1009
Phone
(212) 439-5177
NPI assigned
Jan 3, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Surgical Physician Assistant 363AS0400X 028024 NY Primary

Addresses

Primary practice location

635 Madison Ave Ste 1402E
New York, NY 10022-1009

Mailing address

99 Teaneck Rd Apt 312
Ridgefield Park, NJ 07660-2373
Phone (917) 941-2571

Other practice location 1

485 Madison Ave Fl 8
New York, NY 10022-5803
Phone (212) 889-8600

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
Credentials
Physician Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1104587039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 TEANECK RD APT 312",
            "city": "RIDGEFIELD PARK",
            "state": "NJ",
            "postal_code": "076602373",
            "telephone_number": "917-941-2571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 MADISON AVE STE 1402E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100221009",
            "telephone_number": "212-439-5177"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "485 Madison Ave Fl 8",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100225803",
            "country_code": "US",
            "telephone_number": "212-889-8600",
            "fax_number": "212-685-2667",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAMROCK",
        "first_name": "CHRISTINA",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-03",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "028024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.