Individual provider Active NPI

Krista Marie Shanholtz, FNP, RN

  • Nurse Practitioner
  • Columbia, MD
National Provider Identifier
1558978940
Registry record updated Sep 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R253794 Issued in MD
Practice address
11055 Little Patuxent Pkwy Ste 103
Columbia, MD 21044-2908
Phone
(410) 992-9339
NPI assigned
Sep 29, 2020
Last updated
Sep 22, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R253794 MD Primary
Family Nurse Practitioner 363LF0000X 346664 NY
Family Medicine Physician 207Q00000X 346664 NY

Addresses

Primary practice location

11055 Little Patuxent Pkwy Ste 103
Columbia, MD 21044-2908

Mailing address

11055 Little Patuxent Pkwy Ste 103
Columbia, MD 21044-2908
Phone (410) 992-9339

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
I20201222002233 NY Practitioner - Nurse Practitioner 3476965153 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
346664NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Service Group Multi-Specialty CurrentSince Dec 1, 2020 Accepting new patients
Howard County Pediatrics, LLC Multi-Specialty Past Accepting new patients
White Oak Pediatrics, DRS. Battiata & Impeduglia, P.a. Past Accepting new patients

Locations

251 Salina Meadows Pkwy
Ste 100
Syracuse, NY 13212
Phone (315) 464-2000

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

90 Presidential Plz
Fl 3
Syracuse, NY 13202
Phone (315) 464-4357

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.

NPI Registry JSON

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

{
    "created_epoch": "1601337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790035200000",
    "number": "1558978940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11055 LITTLE PATUXENT PKWY STE 103",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210442908",
            "telephone_number": "410-992-9339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11055 LITTLE PATUXENT PKWY STE 103",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210442908",
            "telephone_number": "410-992-9339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANHOLTZ",
        "first_name": "KRISTA",
        "middle_name": "MARIE",
        "credential": "FNP, RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-29",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "R253794",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "346664",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "346664",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

Verify at the official NPI Registry.