Shantel Eccleston

Primary specialty

Critical Care Neonatal Nurse PractitionerTaxonomy code 363LN0005X

License

350494 Issued in NY

Practice address

12103 234TH St
Rosedale, NY 11422-1026

Phone

(347) 232-0792

NPI assigned

Jul 21, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1626825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1255904751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12103 234TH ST",
            "city": "ROSEDALE",
            "state": "NY",
            "postal_code": "114221026",
            "telephone_number": "347-232-0792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12103 234TH ST",
            "city": "ROSEDALE",
            "state": "NY",
            "postal_code": "114221026",
            "telephone_number": "347-232-0792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ECCLESTON",
        "first_name": "SHANTEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-21",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WN0002X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Neonatal Intensive Care",
            "state": "NY",
            "license": "679343",
            "primary": false
        },
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "NY",
            "license": "350494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joy A Duncan, LPN
• Karen E. Duncan, FNP
• Esperanta Dupervil, LCSW
• Cyrtha Durand
• Ngozi Ebhomielen
• Edeyouth Inc
• Edge Medical Services
• Nordia Edwards, NURSE PRACTITIONER
• Nneka Egbuchunam, RN
• Chioma Chituru Egbulefu, RPH

• Critical Care Neonatal Nurse Practitioner in Rosedale, NY
• Providers in Rosedale, NY by specialty
• Critical Care Neonatal Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.