Nikita Shmyrin

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

028767 Issued in NY

Practice address

21 Valley Rd
Stony Brook, NY 11790-1615

Phone

(516) 595-4252

NPI assigned

Aug 29, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678

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.

• New York City Health and Hospitals Corporation

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1679587679
  NPD (past)

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

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1477273613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 VALLEY RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117901615",
            "telephone_number": "516-595-4252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 VALLEY RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117901615",
            "telephone_number": "516-595-4252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHMYRIN",
        "first_name": "NIKITA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-29",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "028767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Shimunov, MD
• Jisung Phillip Shin, MD
• Richard Min Shin, MD
• William D Shin, DO
• Jason Samuel Shinners, DO
• Asya Shor
• Elizabeth M Shortell, NURSE PRACTITIONER
• Gautam Anand Shrivastava, MD, MPH
• Kenneth Reed Shroyer, MD, PHD
• Karim Khaled Shuaib

• Physician Assistant in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.