Shannon D Marzullo, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F305322-1 Issued in NY

Practice address

50 Lakefront Blvd
Suite 130
Buffalo, NY 14202-4345

Phone

(716) 849-8750

Fax

(716) 849-8757

NPI assigned

Mar 4, 2010

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

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Family Choice of New York Medical PC

  • General Practice Physician
  • Depew, NY
  • NPI 1720312754
  Medicare reassignment

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

{
    "created_epoch": "1267660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549843200000",
    "number": "1215250279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3332 WALDEN AVE",
            "address_2": "STE 110",
            "city": "DEPEW",
            "state": "NY",
            "postal_code": "140432400",
            "telephone_number": "716-849-8750",
            "fax_number": "716-849-8757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 LAKEFRONT BLVD",
            "address_2": "SUITE 130",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142024345",
            "telephone_number": "716-849-8750",
            "fax_number": "716-849-8757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARZULLO",
        "first_name": "SHANNON",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-04",
        "last_updated": "2019-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F305322-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03600295",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Agnes Manor
• Jyotsna Mary George, MD
• Maryvale School System
• John M Marzo, M.D.
• Georgia Marzullo, LMSW
• Stephanie Marzullo
• Sylvia Marzullo, PT OCS
• Jameelah Masaed, MSW
• Frank J Mascaro
• Julia Ann Mascaro, AUD

• Adult Health Nurse Practitioner in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; 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.