Shayna Madeleine Saccaro, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

346025 Issued in NY

Practice address

6144 Route 25a Ste 19
Wading River, NY 11792-2015

Phone

(631) 751-0000

Fax

(631) 751-0506

NPI assigned

Oct 18, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

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• Lighthouse Endoscopy, PC

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  • NPI 1437501541

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1224288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1568614733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 ROUTE 112 BLDG 4",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768055",
            "telephone_number": "631-751-0000",
            "fax_number": "631-751-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6144 ROUTE 25A STE 19",
            "city": "WADING RIVER",
            "state": "NY",
            "postal_code": "117922015",
            "telephone_number": "631-751-0000",
            "fax_number": "631-751-0506"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11 Patricia Ct",
            "address_purpose": "LOCATION",
            "city": "Middle Island",
            "state": "NY",
            "postal_code": "119531417",
            "country_code": "US",
            "telephone_number": "631-879-8759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SACCARO",
        "first_name": "SHAYNA",
        "middle_name": "MADELEINE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-18",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "294869",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "346025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• RK Med Imaging Inc
• Robert Bernard M.D. P.C.
• Caitlin Robins, MS
• Alyssa Michelle Romer
• Catherine Ann Rondeau, ARNP
• Yasameen Saleem, PHARMD
• Robin Sayles
• Jill Marie Schroeppel, MA-CCC-SLP-TSHH
• Oliverto Marshall Senobe
• Rachael Sereno

• Family Nurse Practitioner in Wading River, NY
• Providers in Wading River, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.