Active NPI
Shannon Jane Colt, MD
- Pediatrics Physician
- Johnstown, NY
National Provider Identifier
1669560603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 211113
- Practice address
- 110 Decker Drive, Suite 100
Johnstown, NY 12095-2316 - Phone
- (518) 762-6731
- Fax
- (518) 762-7135
- NPI assigned
- Oct 11, 2006
- Last updated
- Jan 21, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 211113 | NY | Primary |
Addresses
Primary practice location
110 Decker Drive, Suite 100
Johnstown, NY 12095-2316
Mailing address
99 E State St
PO Box 1250
Gloversville, NY 12078-1203
Phone (518) 775-4205
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 411485 | Other | NY | MVP HEALTHPLAN |
| 000927742002 | Other | NY | BSH NE NY |
| 01859278 | Medicaid | NY |
Other names 1
- Dr. Shannon Jane Colt-Connaway
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 211113 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421798400000",
"number": "1669560603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "99 E STATE ST",
"address_2": "PO BOX 1250",
"city": "GLOVERSVILLE",
"state": "NY",
"postal_code": "120781203",
"telephone_number": "518-775-4205",
"fax_number": "518-775-4225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 DECKER DRIVE, SUITE 100",
"city": "JOHNSTOWN",
"state": "NY",
"postal_code": "120952316",
"telephone_number": "518-762-6731",
"fax_number": "518-762-7135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLT",
"first_name": "SHANNON",
"middle_name": "JANE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-11",
"last_updated": "2015-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "211113",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP HEALTHPLAN",
"identifier": "411485",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BSH NE NY",
"identifier": "000927742002",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01859278",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SHANNON",
"last_name": "COLT-CONNAWAY",
"middle_name": "JANE",
"prefix": "DR.",
"credential": "MD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Johnstown, NY
- Victoria Caruso, NP
- Kathleen M. Catalano, D.O.
- Catholic Charities of Fulton & Montgomery Counites
- Cindy Christman, RN
- City of Johnstown
- Community Health Center
- Community Health Center
- Community Health Center of St. Mary's Healthcare & Nathan Littauer Hos
- Community Health Center of St. Mary's Healthcare & Nathan Littauer Hos
- Community Health Center of St. Mary's Hospital and Nathan Littauer Hos
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.