Individual provider Active NPI

Shannon Lynn Henning, D.O.

  • Pediatrics Physician
  • Syosset, NY
National Provider Identifier
1194037333
Registry record updated May 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
0102207238 Issued in VA
Practice address
596 Jericho Tpke
Syosset, NY 11791-4522
Phone
(516) 677-5437
NPI assigned
Jul 3, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 263677 NY
Pediatrics Physician 208000000X 0102207238 VA Primary

Addresses

Primary practice location

596 Jericho Tpke
Syosset, NY 11791-4522

Mailing address

13135 Lee Jackson Hwy Ste 201
Fairfax, VA 22033-1907
Phone (812) 322-3108

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130823000314 NY Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 2961645973 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
263677NYMDPediatrics Physician
0102207238VAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Island Emergency Medical Services, P.C. CurrentSince Dec 1, 2013 Accepting new patients
Kim Medical of New York PLLC CurrentSince May 1, 2023 Accepting new patients
Flushing Hospital Medical Center CurrentSince Nov 1, 2015 Accepting new patients
Flushing Hospital & Medical Center CurrentSince Nov 1, 2015 Accepting new patients
Hello Pediatrics Medicine PLLC Pediatrics Past Accepting new patients

Locations

4500 Parsons Blvd
Flushing, NY 11355
Phone (718) 670-5631

14601 45th Ave
Flushing, NY 11355
Phone (718) 670-5562

255 Executive Dr
Ste 210B
Plainview, NY 11803
Phone (516) 687-9563

10 Maple St
Prt Washingtn, NY 11050
Phone (917) 746-5942

50 Route 25A
Smithtown, NY 11787
Phone (631) 465-6225

Interoperability endpoints

  • Direct secure messaging: shannon.henning@hellopeds.eclinicaldirectplus.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1278115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653004800000",
    "number": "1194037333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13135 LEE JACKSON HWY STE 201",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331907",
            "telephone_number": "812-322-3108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "596 JERICHO TPKE",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117914522",
            "telephone_number": "516-677-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNING",
        "first_name": "SHANNON",
        "middle_name": "LYNN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-03",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "263677",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0102207238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syosset, NY

Sources for this page

Verify at the official NPI Registry.