Active NPI
Shauna L Malta
- Specialist
- New Hartford, NY
National Provider Identifier
1497918411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 006922-1
- Practice address
- 2050 Tilden Ave
Box 1000
New Hartford, NY 13413-3613 - Phone
- (315) 797-3114
- Fax
- (315) 624-0474
- NPI assigned
- Jul 9, 2008
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 006922-1 | NY | Primary |
Addresses
Primary practice location
2050 Tilden Ave
Box 1000
New Hartford, NY 13413-3613
Mailing address
2050 Tilden Ave
Box 1000
New Hartford, NY 13413-3613
Phone (315) 797-3114
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01815443 | Medicaid | NY | |
| 00313539 | Medicaid | NY |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006922-1 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215561600000",
"number": "1497918411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2050 TILDEN AVE",
"address_2": "BOX 1000",
"city": "NEW HARTFORD",
"state": "NY",
"postal_code": "134133613",
"telephone_number": "315-797-3114",
"fax_number": "315-624-0474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2050 TILDEN AVE",
"address_2": "BOX 1000",
"city": "NEW HARTFORD",
"state": "NY",
"postal_code": "134133613",
"telephone_number": "315-797-3114",
"fax_number": "315-624-0474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALTA",
"first_name": "SHAUNA",
"middle_name": "L",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-09",
"last_updated": "2008-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "006922-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01815443",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00313539",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Hartford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.