Shana Marie Glynn, MS, RPA-C, RD, CDN

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

019490 Issued in NY

Practice address

525 Jan Way
Calverton, NY 11933

Phone

(631) 508-5400

Fax

(631) 910-2322

NPI assigned

Nov 9, 2015

Last updated

May 15, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

State licenses

Practice roles

Locations

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.

• Ebdk at Calverton

  dba Wellbridge

  • Substance Abuse Rehabilitation Facility
  • Calverton, NY
  • NPI 1528609799
  NPD

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

{
    "created_epoch": "1447027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1174996334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 JAN WAY",
            "city": "CALVERTON",
            "state": "NY",
            "postal_code": "119333005",
            "telephone_number": "631-508-5400",
            "fax_number": "631-910-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 JAN WAY",
            "city": "CALVERTON",
            "state": "NY",
            "postal_code": "11933",
            "telephone_number": "631-508-5400",
            "fax_number": "631-910-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLYNN",
        "first_name": "SHANA",
        "middle_name": "MARIE",
        "credential": "MS, RPA-C, RD, CDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-09",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "019490",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "007626",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desiree Simone Dalrymple
• VI Dao, RN
• Marie Davis
• Ebdk at Calverton (Wellbridge)
• Ashleigh Kristin Gardner, LCSW
• Alison Ann Gomez
• Jette Grefe, RN
• Edmond Hakimi, D.O
• Healthcare Support Systems, Inc.
• Jennifer S James, RN

• Physician Assistant in Calverton, NY
• Providers in Calverton, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; 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.