Shelley Mae Bacon, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

342993 Issued in NY

Practice address

4979 Harlem Rd
Amherst, NY 14226-2547

Phone

(716) 923-4380

Fax

(716) 923-4384

NPI assigned

Jun 19, 2018

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

Medicare fee-for-service enrollment

Enrolled in NY

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

Nurse Practitioner

State licenses

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.

• Brookview Medical Associates, PLLC

  • General Practice Physician
  • Bohemia, NY
  • NPI 1871965855
  Medicare reassignment NPD
• Wny Medical PC

  • Internal Medicine Physician
  • Amherst, NY
  • NPI 1154421246

  Family

  Medicare reassignment NPD

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

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529366400000",
    "number": "1669966065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4979 HARLEM RD",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142262547",
            "telephone_number": "716-923-4380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4979 HARLEM RD",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142262547",
            "telephone_number": "716-923-4380",
            "fax_number": "716-923-4384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "SHELLEY",
        "middle_name": "MAE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-19",
        "last_updated": "2018-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "342993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony M. Avellanosa, M.D.
• Awaken Performance Rehab LLC
• Michelle Elizabeth Azara, RN
• Tiffany Azzinaro, LCSWR
• Sandra J Bach, M.S., ED.
• Barbara L Baer, RN
• Karen Baetzhold, R.P.A.
• Beverly Patricia Baglio
• David L Bagnall, MD
• Mirza A Baig, D.O.

• Family Nurse Practitioner in Amherst, NY
• Providers in Amherst, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; 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.