Individual provider Active NPI

Elizabeth Shannon, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Rochester, NY
National Provider Identifier
1578931762
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F401910-1 Issued in NY
Practice address
2300 East Ave
Rochester, NY 14610-2564
Phone
(585) 201-8155
Fax
(585) 340-7973
NPI assigned
Sep 4, 2015
Last updated
Jan 30, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F401910-1 NY Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F401910 NY

Addresses

Primary practice location

2300 East Ave
Rochester, NY 14610-2564

Mailing address

2300 East Ave
Rochester, NY 14610-2564
Phone (585) 201-8155

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
I20170131001169 NY Practitioner - Nurse Practitioner 0446532287 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F401910NYMDPsychiatric/Mental Health Nurse Practitioner
F401910-1NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Rochester CurrentSince Aug 1, 2017 Accepting new patients
University of Rochester Current Accepting new patients
University of Rochester CurrentSince Aug 1, 2017 Accepting new patients

Locations

300 Crittenden Blvd
Rochester, NY 14642
Phone (585) 275-3569

601 Elmwood Ave
Rochester, NY 14642
Phone (585) 275-9555

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": "1441324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1578931762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 EAST AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146102564",
            "telephone_number": "585-201-8155",
            "fax_number": "585-340-7973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 EAST AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146102564",
            "telephone_number": "585-201-8155",
            "fax_number": "585-340-7973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "ELIZABETH",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-04",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F401910-1",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F401910",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.