Individual provider Active NPI

Shivani S Shah, M.D

  • Pediatrics Physician
  • Staten Island, NY
National Provider Identifier
1245579226
Registry record updated Jul 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
292168 Issued in NY
Practice address
135 Canal St Ste 200
Staten Island, NY 10304
Phone
(917) 830-1950
NPI assigned
Feb 11, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 292168 NY
Pediatrics Physician 208000000X 292168 NY Primary

Addresses

Primary practice location

135 Canal St Ste 200
Staten Island, NY 10304

Mailing address

46 Albion St
Bridgeport, CT 06605-2602
Phone (646) 724-0532

Other identifiers 1

IdentifierTypeStateIssuer
292168OtherNYNY STATE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190215001990 NY Practitioner - Pediatric Medicine 1658619671 Reassigns benefits to 3 organizations
I20240424001343 NJ Practitioner - Pediatric Medicine 1658619671 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
292168NYMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Affiliate Group of New York PC CurrentSince Mar 1, 2024 Accepting new patients
North Shore-Lij Medical PC CurrentSince May 13, 2023 Accepting new patients
Metropolitan Medical Practice Plan PC CurrentSince Mar 1, 2019 Accepting new patients
Valley Physician Services PC CurrentSince May 1, 2024 Accepting new patients
North Shore - Lij Medical PC CurrentSince May 13, 2023 Accepting new patients

Locations

135 N Kinderkamack Rd
Montvale, NJ 07645
Phone (201) 476-0040

223 N Van Dien Ave
Ridgewood, NJ 07450
Phone (201) 447-8417

223 N Van Dien Ave
Fl 1
Ridgewood, NJ 07450

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

100 E 77th St
New York, NY 10075
Phone (212) 434-2606

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

1901 1st Ave
New York, NY 10029
Phone (212) 230-6262

300 Community Dr
Plandome, NY 11030

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: shivani.shah.1@5622.direct.athenahealth.com
  • Direct secure messaging: sshah848516@nychhc.direct-ci.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": "1360540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531872000000",
    "number": "1245579226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 ALBION ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066052602",
            "telephone_number": "646-724-0532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 CANAL ST STE 200",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10304",
            "telephone_number": "917-830-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SHIVANI",
        "middle_name": "S",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-11",
        "last_updated": "2018-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NY",
            "license": "292168",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "292168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY STATE",
            "identifier": "292168",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.