Active NPI
Shelley Dawn Hollis
- Physical Therapist
- New York, NY
National Provider Identifier
1457695801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 62 034023
- Practice address
- 180 W End Ave
New York, NY 10023-4902 - Phone
- (212) 600-4781
- NPI assigned
- Nov 23, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 62 034023 | NY | Primary |
Addresses
Primary practice location
180 W End Ave
New York, NY 10023-4902
Mailing address
259 Bennett Ave
Apt 2E
New York, NY 10040-2471
Phone (347) 369-7055
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034023 | NY | MD | Pharmacist |
| 62 034023 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prohealth & Fitness | Physical Therapist | 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 and National Provider Directory roles.
-
- Physical Therapist
- Edison, NJ
- NPI 1629206289
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512864000000",
"number": "1457695801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "259 BENNETT AVE",
"address_2": "APT 2E",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100402471",
"telephone_number": "347-369-7055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "180 W END AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100234902",
"telephone_number": "212-600-4781"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLIS",
"first_name": "SHELLEY",
"middle_name": "DAWN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-11-23",
"last_updated": "2017-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "62 034023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.