Active NPI
Shane Anand Persaud, PHARMD
- Pharmacist
- Valley Stream, NY
National Provider Identifier
1164059119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 068783
- Practice address
- 900 Franklin Ave
Valley Stream, NY 11580-2145 - Phone
- (516) 256-6000
- NPI assigned
- Mar 26, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 068783 | NY | Primary |
Addresses
Primary practice location
900 Franklin Ave
Valley Stream, NY 11580-2145
Mailing address
11546 117TH St
South Ozone Park, NY 11420-2329
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 068783 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644883200000",
"number": "1164059119",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11546 117TH ST",
"city": "SOUTH OZONE PARK",
"state": "NY",
"postal_code": "114202329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 FRANKLIN AVE",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115802145",
"telephone_number": "516-256-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERSAUD",
"first_name": "SHANE",
"middle_name": "ANAND",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-26",
"last_updated": "2022-02-15",
"certification_date": "2022-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "068783",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valley Stream, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.