Individual provider Active NPI

Shevvie Sialana

  • Physical Therapist
  • Ridgewood, NY
National Provider Identifier
1568009116
Registry record updated Dec 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
044144 Issued in NY
Practice address
6805 Fresh Pond Rd
Ridgewood, NY 11385-5200
Phone
(718) 456-2543
Fax
(718) 559-6784
NPI assigned
Dec 3, 2019
Last updated
Dec 3, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 044144 NY Primary

Addresses

Primary practice location

6805 Fresh Pond Rd
Ridgewood, NY 11385-5200

Mailing address

6805 Fresh Pond Rd
Ridgewood, NY 11385-5200
Phone (718) 456-2543

Other practice location 1

4618 Broadway
Astoria, NY 11103-1628
Phone (718) 274-4200

Other identifiers 1

IdentifierTypeStateIssuer
044144OtherNYSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191206002021 NY Practitioner - Physical Therapist in Private Practice 3779916663 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.87 of 100Reported as group
Quality
88.31
Improvement activities
40
Cost
69.4

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
044144NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Spear Physical and Occupational Therapy, LLC Physical Therapist CurrentSince Oct 19, 2022 Accepting new patients
New York Luna Care Physical Therapy PLLC Physical Therapist CurrentSince May 16, 2023 Accepting new patients
Grzegorz Wolski PT PC Physical Therapist CurrentSince Apr 1, 2021 Accepting new patients
Fresh Pond Physical Therapy Astoria, P.C. Physical Therapist CurrentSince Nov 3, 2019 Accepting new patients
Fresh Pond Physical Therapy Greenpoint, P.C Physical Therapist PastSince Aug 12, 2025 Accepting new patients

Locations

4618 Broadway
Astoria, NY 11103
Phone (718) 274-4200

120 E 56th St
Rm 1010
New York, NY 10022
Phone (646) 790-7466

31 E 32nd St
Fl 4
New York, NY 10016
Phone (646) 973-5427

36 W 44th St
Ste 403
New York, NY 10036
Phone (212) 759-2280

1 Blue Hill Plz
Ste 1509
Pearl River, NY 10965
Phone (201) 914-0063

Organizations & group practices 6

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": "1575331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575331200000",
    "number": "1568009116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6805 FRESH POND RD",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113855200",
            "telephone_number": "718-456-2543",
            "fax_number": "718-559-6784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6805 FRESH POND RD",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "113855200",
            "telephone_number": "718-456-2543",
            "fax_number": "718-559-6784"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4618 Broadway",
            "address_purpose": "LOCATION",
            "city": "Astoria",
            "state": "NY",
            "postal_code": "111031628",
            "country_code": "US",
            "telephone_number": "718-274-4200",
            "fax_number": "718-559-6784",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIALANA",
        "first_name": "SHEVVIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-03",
        "last_updated": "2019-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "044144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "044144",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgewood, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.