Active NPI
Krystal Nicole Callahan, PA
- Physician Assistant
- Bay Shore, NY
National Provider Identifier
1134935448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 032456-01
- Practice address
- 301 E Main St
Bay Shore, NY 11706-8408 - Phone
- (631) 968-3000
- NPI assigned
- Dec 10, 2024
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 032456-01 | NY | Primary |
Addresses
Primary practice location
301 E Main St
Bay Shore, NY 11706-8408
Mailing address
17 Superior St
Port Jefferson Station, NY 11776-4329
Phone (631) 624-0823
Other practice location 1
17 Superior St
Port Jefferson Station, NY 11776-4329
Phone (631) 624-0823
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 032456-01 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1733788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733788800000",
"number": "1134935448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 SUPERIOR ST",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "117764329",
"telephone_number": "631-624-0823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 E MAIN ST",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117068408",
"telephone_number": "631-968-3000"
}
],
"practiceLocations": [
{
"address_1": "17 Superior St",
"address_purpose": "LOCATION",
"city": "Port Jefferson Station",
"state": "NY",
"postal_code": "117764329",
"country_code": "US",
"telephone_number": "631-624-0823",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CALLAHAN",
"first_name": "KRYSTAL",
"middle_name": "NICOLE",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-12-10",
"last_updated": "2024-12-10",
"certification_date": "2024-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "032456-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bay Shore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.