Shari Koller, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

020019 Issued in NY

Practice address

501 State Route 208
Monroe, NY 10950-1611

Phone

(845) 286-3600

NPI assigned

Sep 19, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Forest Hills Dermatology Group PLLC

  • Dermatology Physician
  • Kew Gardens, NY
  • NPI 1225309586
  NPD (past)

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

{
    "created_epoch": "1474243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1346798402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 GREENBRIAR ST",
            "city": "BERGENFIELD",
            "state": "NJ",
            "postal_code": "076214107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 STATE ROUTE 208",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109501611",
            "telephone_number": "845-286-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLER",
        "first_name": "SHARI",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-19",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "020019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Klein, LMSW
• Samuel Klein, LMSW
• Solomon Eli Klein, O.D.
• Fredric Jay Kneller, D.D.S.
• Amy H Kolakowski, LCSW
• Kelly Kopp
• Mitchell Joseph Korn, P.T.
• Diana Kornberg
• Victoria Kowalski
• Mihaela Krachtus, FNP

• Physician Assistant in Monroe, NY
• Providers in Monroe, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; 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.