Shannon Gulliver Caspersen, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

259217-1 Issued in NY

Practice address

980 Madison Avenue
Suite # 207
New York, NY 10075

Phone

(646) 397-4680

NPI assigned

Apr 9, 2009

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

Other names 1

• Dr. Shannon Alexandra Gulliver Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 31, 2018 through Jan 31, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1239235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395273600000",
    "number": "1801039656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 EAST 96TH STREET",
            "address_2": "#4C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10128",
            "telephone_number": "646-397-4680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 MADISON AVENUE",
            "address_2": "SUITE # 207",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10075",
            "telephone_number": "646-397-4680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASPERSEN",
        "first_name": "SHANNON",
        "middle_name": "GULLIVER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-09",
        "last_updated": "2014-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "259217-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "GULLIVER",
            "middle_name": "ALEXANDRA",
            "prefix": "DR.",
            "credential": "M.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kimberly Caspare, DPT, ATC, CSCS, CES
• Daniel Patrick Casper, RPA-C
• Holly Casper, MSED
• Sydney Keane Casper, PA-C
• Christopher G Caspers, M.D.
• Jules Augustine Moscoso Caspillo, DPT
• Louielah Casquejo
• David Gerard Cassagnol, M.D.
• Dena Cassagnol, RN
• Emlyne Cassagnol

• Psychiatry Physician in New York, NY
• Providers in New York, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.