Soo Yeon Shin

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

346297 Issued in NY

Practice address

134 Homer Ave
Cortland, NY 13045-1206

Phone

(607) 756-3500

NPI assigned

Jul 30, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: sshin162312@direct-guthrie.org

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.

• Guthrie Medical Group PC

  • Clinical Medical Laboratory
  • Sayre, PA
  • NPI 1649225855
  NPD (past)

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614902400000",
    "number": "1205445640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-888-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 HOMER AVE",
            "city": "CORTLAND",
            "state": "NY",
            "postal_code": "130451206",
            "telephone_number": "607-756-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "SOO YEON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-30",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "346297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sshin162312@direct-guthrie.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "134 Homer Ave",
            "city": "Cortland",
            "state": "NY",
            "country_code": "US",
            "postal_code": "130451206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• William Y Shang, M.D.
• Munish Sharma, MD
• Justine Broome Shay, OTR/L
• Ning Shen, MD
• Lizabeth Sherman, ATC, CES
• Lisa Gale Sholar, LMSW, CSSW
• Deborah Lynne Short Siemer, M.A.
• Mary Jo Shorts, RN
• Ann Handman Siegle
• Annmarie Antoinette Silburn, LPN

• Family Nurse Practitioner in Cortland, NY
• Providers in Cortland, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.