Shyla Imani Kissoon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00614400 Issued in NJ

Practice address

20 Valley St Ste 320
South Orange, NJ 07079-2881

Phone

(973) 313-1113

NPI assigned

Sep 1, 2020

Last updated

Aug 9, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Goldson Medical Associates, LLC

  • Internal Medicine Physician
  • South Orange, NJ
  • NPI 1184668485
  Medicare reassignment

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

{
    "created_epoch": "1598918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628467200000",
    "number": "1790399483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4830 NW 7TH ST",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333171410",
            "telephone_number": "954-655-7641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 VALLEY ST STE 320",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792881",
            "telephone_number": "973-313-1113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4830 NW 7th St",
            "address_purpose": "LOCATION",
            "city": "Plantation",
            "state": "FL",
            "postal_code": "333171410",
            "country_code": "US",
            "telephone_number": "954-655-7641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISSOON",
        "first_name": "SHYLA",
        "middle_name": "IMANI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-01",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00614400",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9113364",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Toby Breitstein Kaufman, PH.D.
• Kids Docs,PC
• Kidzdoc MD Pediatrics LLC (Pediatrics on Prospect)
• Lisa Killian
• Kinetic Studio, LLC
• Kka Ventures LLC (Homewatch Caregivers of South Orange)
• Katherine Kong, PHARM.D.
• Sarah L Kono, M.S.
• Steven Koretzky, DMD
• Kristian Lynch, LCSW, LLC

• Physician Assistant in South Orange, NJ
• Providers in South Orange, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; 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.