Shantell S Wray, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

002435 Issued in CT

Practice address

1296 W Broad St
Groveland, FL 34736-2012

Phone

(407) 905-8827

Fax

(352) 429-5606

NPI assigned

Oct 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 1, 2026 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles (8 of 9)

Locations

Networks

• Freedom Health HMO Network

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.

• Adventist Health System/ Sunbelt, Inc.

  • Urgent Care Clinic/Center
  • The Villages, FL
  • NPI 1396605440

  Physician Assistant

  NPD
• Adventist Health System/Sunbelt, Inc.

  • Urgent Care Clinic/Center
  • Ormond Beach, FL
  • NPI 1235637471

  Physician Assistant

  NPD
• Community Health Centers, Inc

  • Primary Care Clinic/Center
  • Winter Garden, FL
  • NPI 1306935606
  NPD
• Community Health Centers, Inc

  • Primary Care Clinic/Center
  • Orlando, FL
  • NPI 1396829677
  NPD
• Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Orlando, FL
  • NPI 1710259965
  NPD
• Central Brooklyn Medical Group PC

  • Allergy Physician
  • New York, NY
  • NPI 1689627184
  NPD (past)
• Horizon Medical Group, P.C.

  • Durable Medical Equipment & Medical Supplies
  • Yorktown Heights, NY
  • NPI 1386520021
  NPD (past)
• Human Services Council

  • Community/Behavioral Health Agency
  • Norwalk, CT
  • NPI 1568592293
  NPD (past)

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

{
    "created_epoch": "1160870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1609966993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S WOODLAND ST",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347873546",
            "telephone_number": "407-905-8827",
            "fax_number": "407-905-8998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1296 W BROAD ST",
            "city": "GROVELAND",
            "state": "FL",
            "postal_code": "347362012",
            "telephone_number": "407-905-8827",
            "fax_number": "352-429-5606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRAY",
        "first_name": "SHANTELL",
        "middle_name": "S",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-15",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "002435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1071883",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115500100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Belle Marie Williams, LCSW
• Gelsomina Francesca Williams, LMHC
• Winfresh Homemaker & Companion Services LLC
• Nicole Ashley Wolan, RN
• Erika L Woolf, PSY.D
• Kathryn Jean Young
• Richard Young

• All providers in Groveland, FL
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.