Individual provider Active NPI

Kathleen A Shea, C.P.N.P.

  • Pediatric Nurse Practitioner
  • White Plains, NY
National Provider Identifier
1518029818
Registry record updated Oct 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
F380132 Issued in NY
Practice address
210 Westchester Ave
White Plains, NY 10604-2901
Phone
(914) 682-0731
NPI assigned
Dec 14, 2006
Last updated
Oct 15, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X F380132 NY Primary

Addresses

Primary practice location

210 Westchester Ave
White Plains, NY 10604-2901

Mailing address

210 Westchester Ave
White Plains, NY 10604-2901
Phone (914) 682-0731

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
I20110919000339 NY Practitioner - Nurse Practitioner 3274704507 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F380132NYMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Jul 13, 2018 Accepting new patients
Montefiore Medical Center CurrentSince Jul 13, 2018 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

3411 Wayne Ave
Fl 7
Bronx, NY 10467
Phone (718) 741-2332

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

Networks

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

Interoperability endpoints

  • Direct secure messaging: kashea@montefioredirect.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381795200000",
    "number": "1518029818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 WESTCHESTER AVE",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106042901",
            "telephone_number": "914-682-0731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 WESTCHESTER AVE",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106042901",
            "telephone_number": "914-682-0731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEA",
        "first_name": "KATHLEEN",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "C.P.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-14",
        "last_updated": "2013-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "F380132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Plains, NY

Sources for this page

Verify at the official NPI Registry.