Shannon Poulose, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

222 Station PLZ N Ste 509
Mineola, NY 11501-3893

Phone

(516) 663-2381

NPI assigned

Jun 1, 2022

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 NH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: spoulose498218@nyumc.direct-ci.com

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

{
    "created_epoch": "1654041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1699414243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 STATION PLZ N STE 509",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013893",
            "telephone_number": "516-663-2381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 STATION PLZ N STE 509",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013893",
            "telephone_number": "516-663-2381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULOSE",
        "first_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-01",
        "last_updated": "2024-04-30",
        "certification_date": "2022-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon L Postiglione
• Renee Potashner, MD
• Carol Marcia Potruch, LCSW, PHD
• Jayne Potter, LCSW
• James Vanarsdale Potts, DO
• Anthony Powers
• Megan Beatrice Powers, PA-C
• Thaleshravi Prashad, FNP-C
• Oneka Pratt, RPAC
• Kristine Ann Prazak, RPA-C

• Student in an Organized Health Care Education/Training Program in Mineola, NY
• Providers in Mineola, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; 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.