Active NPI
Mimoza Shehu, PA-C
- Medical Physician Assistant
- Lynn, MA
National Provider Identifier
1235648585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 6301
- Practice address
- 269 Union St
Lynn, MA 01901-1314 - Phone
- (781) 581-3900
- NPI assigned
- Sep 29, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 6301 | MA | Primary |
Addresses
Primary practice location
269 Union St
Lynn, MA 01901-1314
Mailing address
30 Baldwin St Unit 1
Malden, MA 02148-2802
Phone (860) 406-1366
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180117002671 | MA | Order and Referring Only - Physician Assistant | 5496014565 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506643200000",
"number": "1235648585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 BALDWIN ST UNIT 1",
"city": "MALDEN",
"state": "MA",
"postal_code": "021482802",
"telephone_number": "860-406-1366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "269 UNION ST",
"city": "LYNN",
"state": "MA",
"postal_code": "019011314",
"telephone_number": "781-581-3900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEHU",
"first_name": "MIMOZA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-29",
"last_updated": "2017-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MA",
"license": "6301",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2017; 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.