Active NPI
Shakara Simone Perez, M.S.ED
- Specialist
- Mount Vernon, NY
National Provider Identifier
1639919574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1794100241
- Practice address
- 131 W 2ND St
Mount Vernon, NY 10550-2943 - Phone
- (646) 233-8350
- NPI assigned
- May 29, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1794100241 | NY | Primary |
Addresses
Primary practice location
131 W 2ND St
Mount Vernon, NY 10550-2943
Mailing address
131 W 2ND St
Mount Vernon, NY 10550-2943
Phone (646) 233-8350
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1794100241 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716940800000",
"number": "1639919574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "131 W 2ND ST",
"city": "MOUNT VERNON",
"state": "NY",
"postal_code": "105502943",
"telephone_number": "646-233-8350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "131 W 2ND ST",
"city": "MOUNT VERNON",
"state": "NY",
"postal_code": "105502943",
"telephone_number": "646-233-8350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ",
"first_name": "SHAKARA",
"middle_name": "SIMONE",
"name_prefix": "Ms.",
"credential": "M.S.ED",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-29",
"last_updated": "2024-05-29",
"certification_date": "2024-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "1794100241",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.