Individual provider Active NPI

Marie Shehata

  • Physician Assistant
  • Ithaca, NY
National Provider Identifier
1801612825
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
953 Danby Rd
Ithaca, NY 14850-7000
Phone
(607) 274-3011
NPI assigned
Nov 25, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

953 Danby Rd
Ithaca, NY 14850-7000

Mailing address

953 Danby Rd
Ithaca, NY 14850-7000

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250727000103 NJ Practitioner - Physician Assistant 4082121942 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Passaic River Observation, LLCGroup PAC ID 0143617126, 27 clinicians

Practice addresses (Care Compare)

224 Hamburg Tpke
Wayne, NJ 07470-2168
Phone (973) 942-6900

703 Main St
Paterson, NJ 07503-2621
Phone (973) 754-2000

Hospital & facility affiliations

  • St Joseph'S University Medical Center Inc Hospital, Paterson, NJ, CCN 310019

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Passaic River Physicians, LLC CurrentSince Jun 1, 2025 Accepting new patients

Locations

5665 New Northside Dr
Ste 320
Sandy Springs, GA 30328
Phone (770) 874-5468

703 Main St
Paterson, NJ 07503
Phone (973) 754-2240

Organizations & group practices 2

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": "1732492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1801612825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "953 DANBY RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148507000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "953 DANBY RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148507000",
            "telephone_number": "607-274-3011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEHATA",
        "first_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-25",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

Verify at the official NPI Registry.