Shandel Douglas, APN
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · River Edge, NJ
NPI 1649798455 · NPPES record last updated Dec 31, 2025
Key facts
- NPI
- 1649798455
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 26NJ00747600 (NJ)
- Practice address
- 887 Kinderkamack Rd
River Edge, NJ 07661-2307 - Phone
- (201) 464-0860
- NPI assigned
- Aug 31, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 12
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Lifebulb LLC
Evergreen Medical Group PC
Practice addresses (Care Compare)
505 Main St
Toms River, NJ 08753-7443
Phone (732) 272-0127
887 Kinderkamack Rd
Suite 2
River Edge, NJ 07661-2307
Phone (201) 791-7771
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171113003306 | NJ | Practitioner - Nurse Practitioner | 7012273790 | Reassigns benefits to 7 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NJ00747600 | NJ | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harmony Medical Services of New Jersey LLC | Current |
Accepting new patients | |
| Thrive Counseling LLC | Current |
Accepting new patients | |
| Lifebulb LLC | Current |
Accepting new patients | |
| JLS Medical PC | Psychiatric/Mental Health | Current |
Accepting new patients |
| Harmony Medical Services of New Jersey LLC | Current |
Accepting new patients | |
| Evergreen Medical Group PC | Psychiatric/Mental Health | Current |
Accepting new patients |
| Visiting Nurse Association of Central Jersey, Inc. | Current |
Accepting new patients | |
| Visiting Nurse Association of Central Jersey, Inc. | Current |
Accepting new patients | |
| Freeway Psychiatry PC | Current |
Accepting new patients | |
| VPS Medical Services, PC | Current |
Accepting new patients | |
| Bancroft, a New Jersey Nonprofit Corporation | Past | Accepting new patients | |
| The Heart Center of the Oranges | Past | Accepting new patients |
Locations
3 Lincoln Hwy
Ste 102A
Edison, NJ 08820
31-00 Broadway
Fair Lawn, NJ 07410
Phone (201) 791-7771
28 Valley Rd
Montclair, NJ 07042
Phone (908) 451-8519
550 Broad St
Ste 606
Newark, NJ 07102
Phone (425) 458-8525
9225 Kennedy Blvd
#F
North Bergen, NJ 07047
Phone (201) 500-9755
887 Kinderkamack Rd
Ste 2
River Edge, NJ 07661
Phone (201) 464-0860
3600 State Route 66
Fl 4
Tinton Falls, NJ 07753
Phone (732) 241-4194
505 Main St
Toms River, NJ 08753
Phone (732) 272-0127
3 Garret Mountain Plz
Ste 200
Woodland Park, NJ 07424
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 26NJ00747600 | NJ | Yes |
| Primary Care Nurse Practitioner | 363LP2300X | 26NJ00747600 | NJ |
Addresses
Primary practice location
887 Kinderkamack Rd
River Edge, NJ 07661-2307
Mailing address
887 Kinderkamack Rd
River Edge, NJ 07661-2307
Phone (201) 464-0860
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0587613 | Medicaid | NJ |
Other providers in River Edge, NJ
- Alexandria Devito
- Damian Joseph Dilauri
- Shira Deborah Donath
- Sharon Doni
- Benjamin Donson
- Dr. Jeanette Honig,Chiropractor LLC
- Delia Duran
- Eastern Acupuncture & Herbs PC
- Charles Ehrlich
- Eihab Human Services New Jersey, Inc.
All providers in River Edge, NJ · Psychiatric/Mental Health Nurse Practitioner in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.