Erastus Shannon, PMH-NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

404594 Issued in NY

Practice address

418 Broadway Ste N
Albany, NY 12207-2922

Phone

(516) 200-6865

NPI assigned

Nov 8, 2022

Sex

Male

Sole proprietor

Yes

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.

• Charles Evans Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bethpage, NY
  • NPI 1972982007
  Medicare reassignment NPD
• Family Service League, Inc.

  • Community/Behavioral Health Agency
  • Huntington, NY
  • NPI 1528093242
  Medicare reassignment NPD
• Charles Evans Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Seaford, NY
  • NPI 1215596614
  NPD

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

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1710695762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "418 BROADWAY STE N",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122072922",
            "telephone_number": "516-200-6865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 BROADWAY STE N",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122072922",
            "telephone_number": "516-200-6865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "ERASTUS",
        "name_prefix": "Mr.",
        "credential": "PMH-NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-08",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "404594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tina Shamszadeh
• Jessica Shanahan IX
• Alyssa Jane Shangraw, PHARMD
• Claire Shanklin
• Don Paul Shannon, LCSW-R
• Patrick Lawrence Shannon, RPA-C
• Alan Shapiro, PH.D.
• Kelsey Renee Shapiro, CRNA
• Linda S Shapiro, PH.D.
• Lois A Shapiro, PH.D

• Psychiatric/Mental Health Nurse Practitioner in Albany, NY
• Providers in Albany, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.