Shabnam Shukrullah, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1800 Jonathan Way
Reston, VA 20190-3592

Phone

(571) 888-9339

NPI assigned

Jun 1, 2024

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 VA, DC2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Potomac Urology Center, LLCGroup PAC ID 1557329406, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Gastrointestinal Specialists LLC

  • Urology Physician
  • Woodbridge, VA
  • NPI 1861588592

  DC

  Medicare reassignment Care Compare group NPD
• Gastrointestinal Specialists LLC

  • Gastroenterology Physician
  • Richmond, VA
  • NPI 1063516672

  DC

  Medicare reassignment

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

{
    "created_epoch": "1717200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717200000000",
    "number": "1346081718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 JONATHAN WAY",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201903592",
            "telephone_number": "571-888-9339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 JONATHAN WAY",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201903592",
            "telephone_number": "571-888-9339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUKRULLAH",
        "first_name": "SHABNAM",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-01",
        "last_updated": "2024-06-01",
        "certification_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deepa Laxmi Shrestha, OTR L
• Ellen Shriver, PT, DPT
• Moshe Shtuhl, PH.D.
• Padma Kant Shukla, MD FACP FACC
• Sima Shukla, M.D.
• Diana Shustarovich, MD
• Elizabeth Hamilton Sibert, PA-C
• Rabelle Siddiki, FNP-BC
• Andrew Jay Siegel, M.D.
• Robert K. Sigal, M.D.

• Physician Assistant in Reston, VA
• Providers in Reston, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 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.
• 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.