Active NPI
Kimberly Shamoun, LBA
- Behavior Analyst
- Elmont, NY
National Provider Identifier
1366997967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 000053-1
- Practice address
- 140 Evans Ave
Elmont, NY 11003-2619 - Phone
- (516) 354-8562
- NPI assigned
- Aug 24, 2016
- Last updated
- Aug 24, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 020486-1 | NY | |
| Behavior Analyst | 103K00000X | 000053-1 | NY | Primary |
Addresses
Primary practice location
140 Evans Ave
Elmont, NY 11003-2619
Mailing address
140 Evans Ave
Elmont, NY 11003-2619
Phone (917) 902-0713
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000053-1 | NY | MD | Occupational Therapy Assistant |
| 020486-1 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Behavioral Intervention Psychological Services PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Hempstead, NY
- NPI 1346591013
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471996800000",
"number": "1366997967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 EVANS AVE",
"city": "ELMONT",
"state": "NY",
"postal_code": "110032619",
"telephone_number": "917-902-0713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 EVANS AVE",
"city": "ELMONT",
"state": "NY",
"postal_code": "110032619",
"telephone_number": "516-354-8562"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAMOUN",
"first_name": "KIMBERLY",
"name_prefix": "Dr.",
"credential": "LBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-24",
"last_updated": "2016-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "020486-1",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NY",
"license": "000053-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmont, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.