Carly Alyse Shamoun, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704314978 Issued in MI

Practice address

9640 Commerce Rd Ste 104
Commerce Township, MI 48382-4167

Phone

(248) 363-1500

NPI assigned

Jul 1, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Carly Alyse Baldassarra Former name

Medicare fee-for-service enrollment

Enrolled in MI

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

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.

• Commerce Internal Medicine, P.C.

  • Internal Medicine Physician
  • Commerce TWP, MI
  • NPI 1730139684
  Medicare reassignment NPD

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

{
    "created_epoch": "1593561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1639796089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 FOUNTAIN PARK DR",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483273529",
            "telephone_number": "248-410-1256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9640 COMMERCE RD STE 104",
            "city": "COMMERCE TOWNSHIP",
            "state": "MI",
            "postal_code": "483824167",
            "telephone_number": "248-363-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAMOUN",
        "first_name": "CARLY",
        "middle_name": "ALYSE",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-01",
        "last_updated": "2023-08-09",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704314978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "BALDASSARRA",
            "middle_name": "ALYSE",
            "credential": "FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Keya Shah
• Lainie M Shapiro, D.D.S., M.S.
• Shauls Individualized Physical Therapy, PC
• Dana D Shea, CCC-SLP
• Christopher Sheena
• Christine Lynn Shepard

• Family Nurse Practitioner in Commerce Township, MI
• Providers in Commerce Township, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; 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.