Active NPI
Heather M Shannon, NP
- Women's Health Nurse Practitioner
- Fulton, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- 00420826
- Practice address
- 522 S 4TH St Ste 500
Fulton, NY 13069 - Phone
- (315) 598-4740
- Fax
- (315) 598-4728
- NPI assigned
- Oct 27, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 00420826 | NY | Primary |
| Advanced Practice Midwife | 367A00000X | F000678-1 | NY |
Addresses
Primary practice location
522 S 4TH St Ste 500
Fulton, NY 13069
Mailing address
239 Oneida St
Fulton, NY 13069-1228
Phone (315) 598-4715
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02381762 | Medicaid | NY |
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Nurse Midwife (CNM)
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
522 S 4TH St
Suite 500
Fulton, NY 13069-2936
Phone (315) 598-4740
Hospital & facility affiliations
- Oswego Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000678 | NY | MD | Acupuncturist |
| 00420826 | NY | MD | Women's Health Nurse Practitioner |
| F000678-1 | NY | MD | Advanced Practice Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oswego County Opportunities, Inc. | Current | Accepting new patients | |
| University OB/GYN Associates | Current | Accepting new patients | |
| Rochester General Hospital | Past | Accepting new patients | |
| Associates for Women'S Medicine PLLC | Past | Accepting new patients | |
| North Country Emergency Medical Consultants,PC | Past | Accepting new patients |
Locations
522 S 4th St
Ste 500
Fulton, NY 13069
Phone (315) 598-4740
239 Oneida St
Fulton, NY 13069
10 George St
Oswego, NY 13126
Phone (315) 342-0880
725 Irving Ave
Ste 600
Syracuse, NY 13210
Phone (315) 464-5162
251 Salina Meadows Pkwy
Ste 100
Syracuse, NY 13212
Phone (315) 464-2000
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Organizations & group practices 5
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.
-
- Multi-Specialty Clinic/Center
- Fulton, NY
- NPI 1740396324
-
- Gynecology Physician
- Syracuse, NY
- NPI 1235170150
-
- Obstetrics & Gynecology Physician
- Syracuse, NY
- NPI 1942258702
-
- Emergency Medicine Physician
- Watertown, NY
- NPI 1972572295
-
- General Acute Care Hospital
- Rochester, NY
- NPI 1063531929
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Oswego, NY
- NPI 1871678458
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757462400000",
"number": "1790775005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "239 ONEIDA ST",
"city": "FULTON",
"state": "NY",
"postal_code": "130691228",
"telephone_number": "315-598-4715",
"fax_number": "315-598-4751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "522 S 4TH ST STE 500",
"city": "FULTON",
"state": "NY",
"postal_code": "13069",
"telephone_number": "315-598-4740",
"fax_number": "315-598-4728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANNON",
"first_name": "HEATHER",
"middle_name": "M",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-27",
"last_updated": "2025-09-10",
"certification_date": "2025-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "NY",
"license": "00420826",
"primary": true
},
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "NY",
"license": "F000678-1",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02381762",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Fulton, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.