Active NPI
Shana Eldridge, B.S.
- Specialist
- Fairport, NY
National Provider Identifier
1518220672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 455509101
- Practice address
- 6 N Main St
Fairport, NY 14450-1524 - Phone
- (585) 377-6590
- NPI assigned
- Jun 22, 2012
- Last updated
- Jun 22, 2012
- 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 | 455509101 | NY | Primary |
Addresses
Primary practice location
6 N Main St
Fairport, NY 14450-1524
Mailing address
6 N Main St
Fairport, NY 14450-1524
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0935 | Other | NY | CENTER FOR AUTISM AND RELATED DISORDERS |
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
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 455509101 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340323200000",
"number": "1518220672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 N MAIN ST",
"city": "FAIRPORT",
"state": "NY",
"postal_code": "144501524"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 N MAIN ST",
"city": "FAIRPORT",
"state": "NY",
"postal_code": "144501524",
"telephone_number": "585-377-6590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELDRIDGE",
"first_name": "SHANA",
"credential": "B.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-22",
"last_updated": "2012-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "455509101",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CENTER FOR AUTISM AND RELATED DISORDERS",
"identifier": "0935",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.