Shane M Sopp, MD

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

141803 Issued in NY

Practice address

4900 Broad Rd
CGH Pob Suite 2V
Syracuse, NY 13215-2265

Phone

(315) 492-5005

Fax

(315) 492-5324

NPI assigned

Sep 26, 2005

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)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Upstate Community Medical, PC

  • Hospitalist Physician
  • Syracuse, NY
  • NPI 1689620163
  NPD (past)

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339977600000",
    "number": "1497741243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2003",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130574503",
            "telephone_number": "315-446-3904",
            "fax_number": "315-445-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 BROAD RD",
            "address_2": "CGH POB SUITE 2V",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132152265",
            "telephone_number": "315-492-5005",
            "fax_number": "315-492-5324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOPP",
        "first_name": "SHANE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2012-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NY",
            "license": "141803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Sonneborn, MSPAS
• Sonus-USA, Inc
• John C Sopchak, LMFT
• Kristin Soper
• Lori Jo Sopko, MOT
• Christina D Sorbello
• Gwen M Sorber, NP
• Mary Sorrendino, L.M.H.C, C.A.S.A.C
• John David Sotherden, LMSW
• Flavia Celeste Soto, MD

• Gynecology Physician in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Gynecology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2012; 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.