Individual provider Active NPI

Shaylah Grant, NP

  • Gerontology Nurse Practitioner
  • Worcester, MA
National Provider Identifier
1356076228
Registry record updated Jul 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
RN2324295 Issued in MA
Practice address
121 Lincoln St Ste 2R
Worcester, MA 01605-2429
Phone
(508) 388-1325
NPI assigned
Jul 23, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X RN2324295 MA Primary
Registered Nurse 163W00000X RN2324295 MA

Addresses

Primary practice location

121 Lincoln St Ste 2R
Worcester, MA 01605-2429

Mailing address

121 Lincoln St Ste 2R
Worcester, MA 01605-2429
Phone (508) 388-1325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20230419002007 MA Practitioner - Nurse Practitioner 8426423716 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN2324295MAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Granted Care Current Accepting new patients
Focused Primary Care PC CurrentSince Feb 1, 2023 Accepting new patients

Locations

100 South St
Ste G08
Southbridge, MA 01550
Phone (508) 764-2620

121 Lincoln St
Ste 2R
Worcester, MA 01605
Phone (508) 388-1325

Interoperability endpoints

  • Direct secure messaging: shaylah.miller.1@28921.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1658534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1356076228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 LINCOLN ST STE 2R",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052429",
            "telephone_number": "508-388-1325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 LINCOLN ST STE 2R",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052429",
            "telephone_number": "508-388-1325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "SHAYLAH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-23",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MA",
            "license": "RN2324295",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "RN2324295",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.