NPIMap

Individual provider Active NPI

Shannon T Evellis, PA-C

  • Physician Assistant
  • Queensbury, NY
National Provider Identifier
1174810808
Registry record updated Oct 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
014844 Issued in NY
Practice address
161 Carey Rd
Queensbury, NY 12804-7821
Phone
(518) 824-8610
Fax
(518) 824-2390
NPI assigned
Jul 1, 2011
Last updated
Oct 8, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 014844 NY Primary

Addresses

Primary practice location

161 Carey Rd
Queensbury, NY 12804-7821

Mailing address

9 Carey Rd
Queensbury, NY 12804-7880
Phone (518) 761-0300

Other practice location 1

100 Broad St
Glens Falls, NY 12801-4349
Phone (518) 792-2223

Other practice location 2

3767 Main St
Warrensburg, NY 12885-1890
Phone (518) 623-2844

Other identifiers 1

IdentifierTypeStateIssuer
03415487MedicaidNY

Other names 1

  • Shannon T Evens Former name

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address shannon.evellis.1@1823.direct.athenahealth.com
Direct Messaging Address shannon.evellis.1@1823.direct.athenahealth.com
Direct Messaging Address shannon.evellis.1@1823.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110811000400 NY Practitioner - Physician Assistant 4688843428 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Albany Medical College of Union University, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hudson Headwaters Health NetworkGroup PAC ID 7416861208, 221 clinicians

Practice addresses (Care Compare)

100 Broad St
Glens Falls, NY 12801-4349
Phone (518) 792-2223

161 Carey Rd
Queensbury, NY 12804-7821
Phone (518) 824-8610

24 Fairfield Ave
Schroon Lake, NY 12870-0292
Phone (518) 532-7120

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
014844NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hudson Headwaters Health Network Physician Assistant CurrentSince Jul 18, 2011 Accepting new patients
Hudson Headwaters Health Network Physician Assistant CurrentSince Jul 18, 2011 Accepting new patients
Hudson Headwaters Health Network Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

6223 State Route 9
Chestertown, NY 12817
Phone (518) 494-2731

100 Broad St
Glens Falls, NY 12801
Phone (518) 792-2223

161 Carey Rd
Queensbury, NY 12804
Phone (518) 480-0011

9 Carey Rd
Queensbury, NY 12804

3767 Main St
Warrensburg, NY 12885
Phone (518) 623-2844

Interoperability endpoints

  • Direct secure messaging: shannon.evellis.1@1823.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791417600000",
    "number": "1174810808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047821",
            "telephone_number": "518-824-8610",
            "fax_number": "518-824-2390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Broad St",
            "address_purpose": "LOCATION",
            "city": "Glens Falls",
            "state": "NY",
            "postal_code": "128014349",
            "country_code": "US",
            "telephone_number": "518-792-2223",
            "fax_number": "518-792-8231",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3767 Main St",
            "address_purpose": "LOCATION",
            "city": "Warrensburg",
            "state": "NY",
            "postal_code": "128851890",
            "country_code": "US",
            "telephone_number": "518-623-2844",
            "fax_number": "518-623-3416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVELLIS",
        "first_name": "SHANNON",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-01",
        "last_updated": "2026-10-08",
        "certification_date": "2026-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03415487",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shannon.evellis.1@1823.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "3767 Main St",
            "city": "Warrensburg",
            "state": "NY",
            "country_code": "US",
            "postal_code": "128851890",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shannon.evellis.1@1823.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "100 Broad St",
            "city": "Glens Falls",
            "state": "NY",
            "country_code": "US",
            "postal_code": "128014349",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shannon.evellis.1@1823.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "161 Carey Rd",
            "city": "Queensbury",
            "state": "NY",
            "country_code": "US",
            "postal_code": "128047821",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "EVENS",
            "middle_name": "T",
            "credential": "RPA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Queensbury, NY

Sources for this page

Verify at the official NPI Registry.