Shantell Dustin, DPT, PTA, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

045013 Issued in NY

Practice address

5190 Transit Rd
Depew, NY 14043-4324

Phone

(716) 651-0100

NPI assigned

Apr 16, 2014

Last updated

Jul 19, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aspire of Western New York Inc.

  • Developmental Disabilities Clinic/Center
  • Cheektowaga, NY
  • NPI 1346337011
  Medicare reassignment NPD
• Buffalo Rehab Group Physical Therapy and Occupational Therapy PC

  • Physical Therapist
  • West Seneca, NY
  • NPI 1548290943
  Medicare reassignment NPD
• Moriarty Physical Therapy, P.C.

  • Physical Therapist
  • Poughkeepsie, NY
  • NPI 1245200518
  Medicare reassignment
• Advanced Therapy, P.L.L.C.

  • Early Intervention Provider Agency
  • Albany, NY
  • NPI 1396907697
  NPD (past)

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

{
    "created_epoch": "1397606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1629498738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 8000 DEPT 314",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142670002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5190 TRANSIT RD",
            "city": "DEPEW",
            "state": "NY",
            "postal_code": "140434324",
            "telephone_number": "716-651-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUSTIN",
        "first_name": "SHANTELL",
        "name_prefix": "Miss",
        "credential": "DPT, PTA, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-16",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "045013",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "008363-1",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "001795",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Douma
• Yennga T Drabik, PHARM D.
• Ellen M Drexler, OT
• Amanda Ducrocq, ORT/L
• Christopher Michael Dukat, ATC
• John Dzik, M.D.
• Eckerd Corporation (Rite Aid Pharmacy 10809)
• Eckerd Corporation (Rite Aid Pharmacy 10808)
• Amy Marie Ehrhardt, LMT
• Rachel Eising

• Physical Therapist in Depew, NY
• Providers in Depew, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.