Individual provider Active NPI

Shannon Zonya Wright Gordon, RPAC

  • Physician Assistant
  • Mineola, NY
National Provider Identifier
1265674014
Registry record updated Mar 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
013048 Issued in NY
Practice address
259 1St St
Mineola, NY 11501-3957
Phone
(516) 663-8312
NPI assigned
Mar 25, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 3, 2026

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

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 013048 NY Primary
Physician Assistant 363A00000X 13601 GA
Physician Assistant 363A00000X PA9121461 FL
Physician Assistant 363A00000X PA95279 MA
Physician Assistant 363A00000X 14252720-1206 UT
Physician Assistant 363A00000X PA70062341 WA
Physician Assistant 363A00000X 8713-23 WI
Physician Assistant 363A00000X PA0009678 CO
Physician Assistant 363A00000X PA01877 RI
Physician Assistant 363A00000X 3601 NH

Addresses

Primary practice location

259 1St St
Mineola, NY 11501-3957

Mailing address

700 Hicksville Rd
Suite204
Bethpage, NY 11714-3471
Phone (516) 576-6106

Other practice location 1

475 Kilvert St
Warwick, RI 02886-1379
Phone (919) 172-8471

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20260131000464 GA Order and Referring Only - Physician Assistant 3971788829

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

12 Cadillac Dr
Suite 300
Brentwood, TN 37027-5272

12 Cadillac Dr
Suite 300
Brentwood, TN 37027-5363

5410 Maryland Way
Suite 400
Brentwood, TN 37027-8087

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3601NHMDPhysical Therapist
PA0009678COMDPhysician Assistant
PA9121461FLMDPhysician Assistant
13601GAMDPhysician Assistant
PA95279MAMDPhysician Assistant
PA01877RIMDPhysician Assistant
14252720-1206UTMDPhysician Assistant
PA70062341WAMDPhysician Assistant
8713-23WIMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: swright@landmarkhealth-direct.org

NPI Registry JSON

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

{
    "created_epoch": "1237939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772496000000",
    "number": "1265674014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 HICKSVILLE RD",
            "address_2": "SUITE204",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117143471",
            "telephone_number": "516-576-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 1ST ST",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013957",
            "telephone_number": "516-663-8312"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 Kilvert St",
            "address_purpose": "LOCATION",
            "city": "Warwick",
            "state": "RI",
            "postal_code": "028861379",
            "country_code": "US",
            "telephone_number": "919-172-8471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WRIGHT GORDON",
        "first_name": "SHANNON",
        "middle_name": "ZONYA",
        "credential": "RPAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-03-25",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "013048",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "13601",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9121461",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA95279",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "14252720-1206",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA70062341",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "8713-23",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA0009678",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA01877",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "3601",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.