Andrea M Shaul, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

F382793-1 Issued in NY

Practice address

639 Main St
Johnson City, NY 13790-1805

Phone

(607) 770-1988

Fax

(607) 770-1988

NPI assigned

Jun 12, 2018

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 PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

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.

• Pediatric and Adolescent Health

  • Pediatric Adolescent Medicine Physician
  • Johnson City, NY
  • NPI 1619923752
  NPD (past)

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

{
    "created_epoch": "1528761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1336632587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 HOSPITAL DR",
            "city": "TOWANDA",
            "state": "PA",
            "postal_code": "188489702",
            "telephone_number": "570-265-6300",
            "fax_number": "570-268-2807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 MAIN ST",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137901805",
            "telephone_number": "607-770-1988",
            "fax_number": "607-770-1988"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "71 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Towanda",
            "state": "PA",
            "postal_code": "188489702",
            "country_code": "US",
            "telephone_number": "570-265-0113",
            "fax_number": "570-268-2812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAUL",
        "first_name": "ANDREA",
        "middle_name": "M",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-12",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "PA",
            "license": "SP017960",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "F382793-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kahaan Shah
• Mahrukh Shahbaz
• Zaid Shakir, MD
• Mary Anne Sharrow, MSPT
• Jennifer Anne Shattuck, N.P.
• Rose M Shea, LMSW
• Derek James Sheffer, PHARM.D, RPH
• Corinne Sherwood, PHARM D
• Neelima A Sheth, MD
• Ling-Ling Shih, CRNA

• Pediatric Nurse Practitioner in Johnson City, NY
• Providers in Johnson City, NY by specialty
• Pediatric Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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.

Verify at the official NPI Registry.