Individual provider Active NPI

Shella Kumar Mongia, MBBS, MD

  • Molecular Genetic Pathology (Pathology) Physician
  • Roslyn, NY
National Provider Identifier
1447458997
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Molecular Genetic Pathology (Pathology) PhysicianTaxonomy code 207ZP0007X
License
ME 110585 Issued in FL
Practice address
381 Elm Dr
Roslyn, NY 11576-3045
Phone
(917) 476-5173
NPI assigned
Jul 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Molecular Genetic Pathology (Pathology) Physician 207ZP0007X 1020797 MA
Molecular Genetic Pathology (Pathology) Physician 207ZP0007X ME 110585 FL Primary

Addresses

Primary practice location

381 Elm Dr
Roslyn, NY 11576-3045

Mailing address

381 Elm Dr
Roslyn, NY 11576-3045
Phone (917) 476-5173

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, GA2 enrollments
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.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230803000434 PA Practitioner - Pathology 4082871272 Reassigns benefits to 1 organization
I20241001000131 GA Practitioner - Pathology 4082871272 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME 110585FLMDMolecular Genetic Pathology (Pathology) Physician
1020797MAMDMolecular Genetic Pathology (Pathology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Conemaugh Physician Practices LLC Current Accepting new patients
DLP Conemaugh Physician Practices LLC CurrentSince Jun 19, 2023 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Aug 1, 2024 Accepting new patients
DLP Conemaugh Physician Practices LLC CurrentSince Jun 19, 2023 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients

Locations

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

1111 Franklin St
Ste 180
Johnstown, PA 15905
Phone (814) 534-3740

1086 Franklin St
Johnstown, PA 15905
Phone (610) 250-4540

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

Organizations & group practices 5

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": "1183680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1447458997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "381 ELM DR",
            "city": "ROSLYN",
            "state": "NY",
            "postal_code": "115763045",
            "telephone_number": "917-476-5173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "381 ELM DR",
            "city": "ROSLYN",
            "state": "NY",
            "postal_code": "115763045",
            "telephone_number": "917-476-5173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONGIA",
        "first_name": "SHELLA",
        "middle_name": "KUMAR",
        "credential": "MBBS, MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-06",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0007X",
            "taxonomy_group": "",
            "desc": "Pathology, Molecular Genetic Pathology",
            "state": "MA",
            "license": "1020797",
            "primary": false
        },
        {
            "code": "207ZP0007X",
            "taxonomy_group": "",
            "desc": "Pathology, Molecular Genetic Pathology",
            "state": "FL",
            "license": "ME 110585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roslyn, NY

Sources for this page

Verify at the official NPI Registry.