Individual provider Active NPI

Heather M Shannon, NP

  • Women's Health Nurse Practitioner
  • Fulton, NY
National Provider Identifier
1790775005
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
00420826 Issued in NY
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

Updated by the provider on Sep 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
02381762MedicaidNY

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041227000160 NY Practitioner - Certified Nurse Midwife (CNM) 3274591128 Reassigns benefits to 2 organizations

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
Oswego County Opportunities, Inc.Group PAC ID 0749176436, 3 clinicians

Practice addresses (Care Compare)

522 S 4TH St
Suite 500
Fulton, NY 13069-2936
Phone (315) 598-4740

Hospital & facility affiliations

  • Oswego Hospital Hospital, Oswego, NY, CCN 330218

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
000678NYMDAcupuncturist
00420826NYMDWomen's Health Nurse Practitioner
F000678-1NYMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Oswego County Opportunities, Inc. CurrentSince Jun 9, 2018 Accepting new patients
University OB/GYN Associates CurrentSince Apr 1, 2012 Accepting new patients
Rochester General Hospital Past Accepting new patients
Associates for Women'S Medicine PLLC PastSince Sep 1, 2012 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

  • FHIR API: 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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

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

Verify at the official NPI Registry.