Individual provider Active NPI

Shauna T Walters, MD

  • Pediatrics Physician
  • Bronx, NY
National Provider Identifier
1518226513
Registry record updated Jul 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
281628-1 Issued in NY
Practice address
3444 Kossuth Ave
Bronx, NY 10467
Phone
(718) 920-2273
NPI assigned
May 10, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 281628-1 NY Primary

Addresses

Primary practice location

3444 Kossuth Ave
Bronx, NY 10467

Mailing address

3444 Kossuth Ave
Bronx, NY 10467-2410
Phone (718) 920-2273

Other practice location 1

3444 Kossuth Ave
Bronx, NY 10467
Phone (718) 920-2273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151215002273 SC Practitioner - Pediatric Medicine 2668773706 Reassigns benefits to 6 organizations
I20191029001364 NY Practitioner - Pediatric Medicine 2668773706 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
281628-1NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Little River Medical Center Inc CurrentSince Oct 19, 2015 Accepting new patients
Little River Medical Center, Inc. Pediatrics CurrentSince Apr 15, 2017 Accepting new patients
Montefiore Medical Center Pediatrics CurrentSince Sep 13, 2019 Accepting new patients
Montefiore Medical Center CurrentSince Sep 13, 2019 Accepting new patients
Little River Medical Center, Inc. CurrentSince Apr 15, 2017 Accepting new patients
Little River Medical Center, Inc. CurrentSince Apr 15, 2017 Accepting new patients
Little River Medical Center, Inc CurrentSince Apr 15, 2017 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

3444 Kossuth Ave
Bronx, NY 10467
Phone (718) 920-2273

4303 Live Oak Dr
Little River, SC 29566
Phone (803) 839-3939

3817 Main St
Loris, SC 29569
Phone (843) 663-8297

4220 Carolina Exchange Dr
Myrtle Beach, SC 29579
Phone (843) 663-8013

3515 Caduceus Dr
Ste B
Myrtle Beach, SC 29588
Phone (843) 651-5689

7724 N Kings Hwy
Myrtle Beach, SC 29572
Phone (843) 839-3939

Networks

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

Interoperability endpoints

  • Direct secure messaging: shwalters@montefioredirect.com

Organizations & group practices 8

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": "1336608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562025600000",
    "number": "1518226513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3444 KOSSUTH AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672410",
            "telephone_number": "718-920-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3444 KOSSUTH AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10467",
            "telephone_number": "718-920-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3444 Kossuth Ave",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "10467",
            "country_code": "US",
            "telephone_number": "718-920-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "SHAUNA",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-10",
        "last_updated": "2019-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "281628-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.