Lisa Marie Shallenberger, MMS, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9110578 Issued in FL

Practice address

4106 W Lake Mary Blvd Ste 205
Lake Mary, FL 32746-3344

Phone

(407) 851-5121

NPI assigned

Aug 28, 2017

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

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Mava Healthcare Systems LLCGroup PAC ID 8123448313, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Mava Healthcare Systems LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kissimmee, FL
  • NPI 1104458769
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1366969578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "859 SILVERADO CT",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327464966",
            "telephone_number": "786-301-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 W LAKE MARY BLVD STE 205",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463344",
            "telephone_number": "407-851-5121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3798 Irvington Ave",
            "address_purpose": "LOCATION",
            "city": "Coconut Grove",
            "state": "FL",
            "postal_code": "331336106",
            "country_code": "US",
            "telephone_number": "786-301-2626",
            "fax_number": "786-301-2626",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHALLENBERGER",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "MMS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-28",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9110578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA9110578",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Harsh Shah
• Savera Shah
• Umang Lalit Shah, M.D
• Iffat Shaheen, MD
• Shakuntala Janwadkar, MD, PA
• Shallie, LLC
• Kristina Shamo, OTR/L
• Balaji Shanmugam, MD
• Sampathkumar Shanmugham, M.D.
• Svitlana Shapovalova, MD

• Physician Assistant in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Physician Assistant in Florida

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