Active NPI
Shiney Sam
- Acute Care Nurse Practitioner
- Bethesda, MD
National Provider Identifier
1770867905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- R165191
- Practice address
- 8901 Wisconsin Ave
Bethesda, MD 20889-0004 - Phone
- (301) 295-4000
- NPI assigned
- Oct 6, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | R165191 | MD | Primary |
Addresses
Primary practice location
8901 Wisconsin Ave
Bethesda, MD 20889-0004
Mailing address
9710 Frederick Rd
Ellicott City, MD 21042-3714
Phone (301) 648-0489
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse, 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": "1317859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698192000000",
"number": "1770867905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9710 FREDERICK RD",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210423714",
"telephone_number": "301-648-0489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8901 WISCONSIN AVE",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208890004",
"telephone_number": "301-295-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAM",
"first_name": "SHINEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-06",
"last_updated": "2023-10-25",
"certification_date": "2023-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "MD",
"license": "R165191",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bethesda, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; 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.