Individual provider Active NPI

Anastasiya Shelestova, A-GNP-C

  • Registered Nurse
  • Corning, NY
National Provider Identifier
1750785085
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
682734 Issued in NY
Practice address
139 Conhocton St
Corning, NY 14830-2945
Phone
(347) 781-7534
NPI assigned
Oct 15, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X AG11220119 NY
Registered Nurse 163W00000X 682734 NY Primary

Addresses

Primary practice location

139 Conhocton St
Corning, NY 14830-2945

Mailing address

139 Conhocton St
Corning, NY 14830-2945
Phone (347) 781-7534

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20260519001272 NY Practitioner - Nurse Practitioner 8628556768 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Daniel S Berman MD Infectious Diseases PCGroup PAC ID 2567723562, 17 clinicians

Practice addresses (Care Compare)

491 State Route 208
Suite 211
Monroe, NY 10950-1656
Phone (718) 633-7828

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
682734NYMDRegistered Nurse
AG11220119NYMDGerontology Nurse Practitioner

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1413331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1750785085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 CONHOCTON ST",
            "city": "CORNING",
            "state": "NY",
            "postal_code": "148302945",
            "telephone_number": "347-781-7534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 CONHOCTON ST",
            "city": "CORNING",
            "state": "NY",
            "postal_code": "148302945",
            "telephone_number": "347-781-7534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELESTOVA",
        "first_name": "ANASTASIYA",
        "credential": "A-GNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-15",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NY",
            "license": "AG11220119",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "682734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corning, NY

Sources for this page

Verify at the official NPI Registry.