Derek Tsai Shang, CRNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

SP021159 Issued in PA

Practice address

269 01 76TH Ave
Queens, NY 11040

Phone

(718) 470-7640

NPI assigned

Nov 14, 2019

Sex

Male

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

Enrolled in PA, NY2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment NPD
• Childrens Health Care Associates, Inc

  • Pediatrics Physician
  • Philadelphia, PA
  • NPI 1598869059
  Medicare reassignment NPD
• Childen'S Health Care Associates Inc.

  • Pediatric Registered Nurse
  • Philadelphia, PA
  • NPI 1699860643
  NPD
• Childrens Health Care Associates of New Jersey PC

  • Pediatrics Physician
  • Voorhees, NJ
  • NPI 1427152917
  NPD (past)

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

{
    "created_epoch": "1573689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648166400000",
    "number": "1851936801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 01 76TH AVE",
            "city": "QUEENS",
            "state": "NY",
            "postal_code": "11040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 01 76TH AVE",
            "city": "QUEENS",
            "state": "NY",
            "postal_code": "11040",
            "telephone_number": "718-470-7640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANG",
        "first_name": "DEREK",
        "middle_name": "TSAI",
        "name_prefix": "Mr.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-14",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "PA",
            "license": "SP021159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Schemitz, LCSW, CASAC
• Therese Joy Pescante Selor, P.T
• Smana Seradieu, LMSW
• Irshaad Faraz Shaffeeullah, M.D.
• Nataliya Shaforost, NP
• Meghana Sharma, DMD
• Zain Shehzad
• Elizabeth A Siaw, MD
• Gurpreet Singh, PA-C
• Raye Singh, RN

• Pediatric Nurse Practitioner in Queens, NY
• Providers in Queens, NY by specialty
• Pediatric Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; 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.