Individual provider Active NPI

Shauna Sanderson, ACNP

  • Acute Care Nurse Practitioner
  • New York, NY
National Provider Identifier
1518572528
Registry record updated Aug 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
30739 Issued in TN
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, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2026

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

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
200001862MedicaidMS
Q071681MedicaidTN

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220210000285 TN Practitioner - Nurse Practitioner 3072924380 Reassigns benefits to 1 organization

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 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2020014482MOMDAcute Care Nurse Practitioner
APRN.CNP.0038521OHMDAcute Care Nurse Practitioner
30739TNMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gastroenterology Center of the Midsouth PLLC Nurse Practitioner CurrentSince Jul 5, 2022 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

  • Direct secure messaging: 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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

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

Verify at the official NPI Registry.