Shawn Patrick Cannon, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

194468 Issued in NY

Practice address

518 Montauk Hwy
Suite 102
Amagansett, NY 11930-2110

Phone

(631) 267-5373

Fax

(631) 267-5376

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311897600000",
    "number": "1831276286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "city": "WAINSCOTT",
            "state": "NY",
            "postal_code": "119750097",
            "telephone_number": "631-267-5373",
            "fax_number": "631-267-5376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 MONTAUK HWY",
            "address_2": "SUITE 102",
            "city": "AMAGANSETT",
            "state": "NY",
            "postal_code": "119302110",
            "telephone_number": "631-267-5373",
            "fax_number": "631-267-5376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "SHAWN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2011-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "194468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01837136",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annette Marshall Physical Therapy Care
• Dawn Breitenbach, LCSW
• Randi Beth Cherill, PT, ATC
• Eugene Mark Connolly, RPA-C
• Erik Peterson Physical Therapy PC
• Victoria Falcone
• Sandra Geehreng Foster, M.AC

• Internal Medicine Physician in Amagansett, NY
• Providers in Amagansett, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.