Individual provider Active NPI

Shota Tchavtchavadze

  • Pharmacist
  • Tarrytown, NY
National Provider Identifier
1699614453
Registry record updated Mar 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
073712 Issued in NY
Practice address
51 N Broadway
Tarrytown, NY 10591-3208
Phone
(914) 631-7266
NPI assigned
Mar 26, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 073712 NY Primary

Addresses

Primary practice location

51 N Broadway
Tarrytown, NY 10591-3208

Mailing address

15B King LN
Brewster, NY 10509-2214

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

State licenses

LicenseStateTypeSpecialty
073712NYMDSchool Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1774483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774483200000",
    "number": "1699614453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15B KING LN",
            "city": "BREWSTER",
            "state": "NY",
            "postal_code": "105092214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 N BROADWAY",
            "city": "TARRYTOWN",
            "state": "NY",
            "postal_code": "105913208",
            "telephone_number": "914-631-7266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TCHAVTCHAVADZE",
        "first_name": "SHOTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-03-26",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "073712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tarrytown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.