Individual provider Active NPI

Shannon Simak, PA-C

  • Physician Assistant
  • Great Neck, NY
National Provider Identifier
1477430346
Registry record updated Mar 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
833 Northern Blvd Ste 160
Great Neck, NY 11021-5322
Phone
(516) 498-8400
NPI assigned
Aug 20, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NY Primary

Addresses

Primary practice location

833 Northern Blvd Ste 160
Great Neck, NY 11021-5322

Mailing address

833 Northern Blvd Ste 160
Great Neck, NY 11021-5322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20250923003410 NY Practitioner - Physician Assistant 9537664404 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brain and Spine Surgeons of New York PCGroup PAC ID 7113818139, 24 clinicians

Practice addresses (Care Compare)

575 Underhill Blvd
Suite 175
Syosset, NY 11791-3417
Phone (516) 704-7004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
034318NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Brain & Spine Surgeons of New York PC CurrentSince Oct 2, 2025 Accepting new patients
Aesthetic Plastic Surgery PC PastSince Aug 1, 2012 Accepting new patients
New York Cardiovascular Anesthesiologists, P.C. Past Accepting new patients

Locations

106 Crystal Brook Hollow Rd
#A
Port Jeff Sta, NY 11776
Phone (631) 509-5250

575 Underhill Blvd
Ste 175
Syosset, NY 11791
Phone (516) 704-7004

4 Westchester Park Dr
Fl 4
White Plains, NY 10604
Phone (914) 948-3008

Networks

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

Organizations & group practices 4

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": "1755648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774137600000",
    "number": "1477430346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 NORTHERN BLVD STE 160",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 NORTHERN BLVD STE 160",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215322",
            "telephone_number": "516-498-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMAK",
        "first_name": "SHANNON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-20",
        "last_updated": "2026-03-22",
        "certification_date": "2026-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

Verify at the official NPI Registry.