Nicole Janelle Shellard, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

012229 Issued in NY

Practice address

5225 Nesconset Hwy
Suite # 30
Port Jefferson Station, NY 11776

Phone

(631) 473-4284

Fax

(631) 331-2204

NPI assigned

May 3, 2010

Last updated

May 3, 2010By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Ny Theraapy Placemeny, Inc

  • Exclusive Provider Organization
  • Lake Grove, NY
  • NPI 1689991788
  NPD (past) Authorized official
• New York Therapy Placement Services

  • Early Intervention Provider Agency
  • Port Jefferson Station, NY
  • NPI 1982060489
  NPD (past)

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

{
    "created_epoch": "1272844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272844800000",
    "number": "1801113667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 SYMPHONY DRIVE",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "11755",
            "telephone_number": "516-209-7618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 NESCONSET HWY",
            "address_2": "SUITE # 30",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "11776",
            "telephone_number": "631-473-4284",
            "fax_number": "631-331-2204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELLARD",
        "first_name": "NICOLE",
        "middle_name": "JANELLE",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-03",
        "last_updated": "2010-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "012229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lee Merrick Shangold, M.D.
• Mark A Shapiro, MD
• Perry Shapiro
• Jessica B. Sharaby-Monaco
• Wajiha Sheikh, PT
• Anna Shepard
• Gerald Shephard, LCSW
• William Hy Sher, M.D.
• Raakhee Nagesh Shirsat, RPH, CDM
• Victoria Shklar, MD

• Occupational Therapist in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Occupational Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.