Marisa Louise Shaker, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

001133 Issued in CT

Practice address

56 Franklin St
Waterbury, CT 06706-1221

Phone

(203) 709-3538

Fax

(203) 709-7258

NPI assigned

Jul 11, 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CT

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

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mshaker2389620@direct.trinity-health.org

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.

• Connecticut Children'S Specialty Group, Inc.

  • Pediatrics Physician
  • Hartford, CT
  • NPI 1669448882
  Medicare reassignment NPD
• Prospect CT Medical Foundation, Inc.

  • Family Medicine Physician
  • Manchester, CT
  • NPI 1144677568
  Medicare reassignment
• Trinity Health of New England Provider Network Organization Inc

  dba Trinity Health Of New England Medical Group

  • Internal Medicine Physician
  • Hartford, CT
  • NPI 1003882812
  Medicare reassignment
• Trinity Health of New England Provider Network Organization Inc

  dba Trinity Health Of New England Medical Group

  • Internal Medicine Physician
  • Waterville, ME
  • NPI 1134779531
  NPD

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1659306314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1090",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060956190",
            "telephone_number": "203-709-3800",
            "fax_number": "203-709-3869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 FRANKLIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061221",
            "telephone_number": "203-709-3538",
            "fax_number": "203-709-7258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAKER",
        "first_name": "MARISA",
        "middle_name": "LOUISE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "001133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mshaker7458@connecticutchildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "56 Franklin St",
            "city": "Waterbury",
            "state": "CT",
            "country_code": "US",
            "postal_code": "067061221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sfme Surgical Supply Inc (St Francis Medical)
• Alexandra Sgro
• Sedat Selajdin Shaban
• Arvind T Shah, MD
• Bajah Shaheed
• Roman Shamuelov, DDS
• Uday Shankar, M.D.
• Pamela Shanks
• Marisa Shanley
• Aliza Shapiro

• Medical Physician Assistant in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Medical Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.