Shannon M Averill, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

753094 Issued in NY

Practice address

91 Fiddlers LN
Latham, NY 12110-5343

Phone

(518) 785-8591

NPI assigned

Dec 12, 2022

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

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.

• North Colonie Central School District

  • School Registered Nurse
  • Latham, NY
  • NPI 1114687811
  NPD
• North Colonie Central School District

  • Pediatric Skilled Nursing Facility
  • Latham, NY
  • NPI 1235597659
  NPD (past)

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

{
    "created_epoch": "1670803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1316658255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 FIDDLERS LN",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121105343",
            "telephone_number": "518-785-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 FIDDLERS LN",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121105343",
            "telephone_number": "518-785-8591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVERILL",
        "first_name": "SHANNON",
        "middle_name": "M",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-12",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "753094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03052893",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "shannon.averill@nccsk12@gmail.org",
            "affiliation": "N",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "work email",
            "address_1": "91 Fiddlers Ln",
            "city": "Latham",
            "state": "NY",
            "country_code": "US",
            "postal_code": "121105343",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jamie Lauren Ascher, DPT
• Lisa Ash
• Julia Allison Cyrilla Ashley
• Associates in Rehabilitation Technology, Inc
• Brittney Aupperle, PA-C
• Alice Bade, O.D.
• Andrea Badurak, SLP
• Jennifer L Baer, NP
• Samantha Baer, LMHC
• Keenan Alex Bailey, MHC

• All providers in Latham, NY
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.