Active NPI
Shauna Sanderson, ACNP
- Acute Care Nurse Practitioner
- New York, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 30739
- Practice address
- 228 Park Ave S Ste 16389
New York, NY 10003-0103 - Phone
- (646) 876-8455
- NPI assigned
- Sep 15, 2020
- Last updated
- Aug 5, 2026
- 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 10
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | TPAN3763 | FL | |
| Acute Care Nurse Practitioner | 363LA2100X | SP034971 | PA | |
| Acute Care Nurse Practitioner | 363LA2100X | 2020014482 | MO | |
| Acute Care Nurse Practitioner | 363LA2100X | 0024196686 | VA | |
| Acute Care Nurse Practitioner | 363LA2100X | APRN.CNP.0038521 | OH | |
| Acute Care Nurse Practitioner | 363LA2100X | C-APN.0105527-C-NP | CO | |
| Acute Care Nurse Practitioner | 363LA2100X | 433742 | NY | |
| Acute Care Nurse Practitioner | 363LA2100X | 1229699 | TX | |
| Acute Care Nurse Practitioner | 363LA2100X | GAA-NP005421 | GA | |
| Acute Care Nurse Practitioner | 363LA2100X | 30739 | TN | Primary |
Addresses
Primary practice location
228 Park Ave S Ste 16389
New York, NY 10003-0103
Mailing address
169 Madison Ave Ste 38114
New York, NY 10016-5101
Phone (646) 876-8455
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200001862 | Medicaid | MS | |
| Q071681 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
PO Box
Germantown, TN 38183
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020014482 | MO | MD | Acute Care Nurse Practitioner |
| APRN.CNP.0038521 | OH | MD | Acute Care Nurse Practitioner |
| 30739 | TN | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gastroenterology Center of the Midsouth PLLC | Nurse Practitioner | Current | Accepting new patients |
| G I Diagnostic and Therapeutic Center LLC | Current | Accepting new patients | |
| Granite State Gastrointestinal Consultants PLLC | Past | Accepting new patients |
Locations
Gastro Onegovt Arhcl
New York, NY 10087
3350 N Germantown Rd
Bartlett, TN 38133
Phone (901) 377-2111
1310 Wolf Park Dr
Germantown, TN 38138
Phone (901) 624-5151
1324 Wolf Park Dr
Germantown, TN 38138
Phone (901) 755-9110
2020 Exeter Rd
Germantown, TN 38138
Phone (901) 682-1233
2999 Centre Oak Way
Germantown, TN 38138
Phone (901) 684-5500
1325 Eastmoreland Ave
Ste 410
Memphis, TN 38104
Phone (901) 261-6650
8000 Wolf River Blvd
Ste 200
Memphis, TN 38138
Phone (901) 684-5503
Interoperability endpoints
- ssanderson33505@mlh.direct-ci.com
Organizations & group practices 3
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.
-
dba Associates In Gastroenterology
- Gastroenterology Physician
- Germantown, TN
- NPI 1417932492
Nurse Practitioner
-
- Endoscopy Clinic/Center
- Germantown, TN
- NPI 1760467732
-
- Gastroenterology Physician
- Londonderry, NH
- NPI 1942214457
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Le Bonheur Children's Hospital
- Children's Hospital
- Memphis, TN
- NPI 1386709871
-
- General Acute Care Hospital
- Memphis, TN
- NPI 1558365890
-
dba Le Bonheur Children's Hospital - Germantown
- Children's Hospital
- Germantown, TN
- NPI 1649654450
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785888000000",
"number": "1518572528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "169 MADISON AVE STE 38114",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100165101",
"telephone_number": "646-876-8455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "228 PARK AVE S STE 16389",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100030103",
"telephone_number": "646-876-8455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDERSON",
"first_name": "SHAUNA",
"credential": "ACNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-15",
"last_updated": "2026-08-05",
"certification_date": "2026-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "FL",
"license": "TPAN3763",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "PA",
"license": "SP034971",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "MO",
"license": "2020014482",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "VA",
"license": "0024196686",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "OH",
"license": "APRN.CNP.0038521",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "CO",
"license": "C-APN.0105527-C-NP",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "NY",
"license": "433742",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "TX",
"license": "1229699",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "GA",
"license": "GAA-NP005421",
"primary": false
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "TN",
"license": "30739",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200001862",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Q071681",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.