NPIMap

Individual provider Active NPI

Laurel J Shambo, PA

  • Physician Assistant
  • Webster, NY
National Provider Identifier
1871881649
Registry record updated Jul 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
015328 Issued in NY
Practice address
1065 Ridge Rd
Webster, NY 14580-2952
Phone
(585) 872-2273
NPI assigned
Jul 14, 2011
Last updated
Jul 8, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X P80534 NY
Physician Assistant 363A00000X 015328 NY Primary

Addresses

Primary practice location

1065 Ridge Rd
Webster, NY 14580-2952

Mailing address

100 Kings Hwy S
Rochester, NY 14617-5504

Other practice location 1

9732 State Route 12
Copenhagen, NY 13626-2906
Phone (315) 688-2305

Other identifiers 1

IdentifierTypeStateIssuer
03417452MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120201000718 NY Practitioner - Physician Assistant 9830356971 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Albany Medical College of Union University, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1425 Portland Ave
Rochester, NY 14621-3001
Phone (585) 922-3122

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P80534NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carthage Area Hospital Inc CurrentSince Oct 1, 2018 Accepting new patients
Carthage Area Hospital Inc CurrentSince Oct 1, 2018 Accepting new patients
Western New York Medical Practice P.C. CurrentSince Aug 18, 2025 Accepting new patients
Rochester General Hospital CurrentSince Aug 18, 2025 Accepting new patients
Rochester General Hospital CurrentSince Aug 18, 2025 Accepting new patients
The Unity Hospital of Rochester CurrentSince Aug 18, 2025 Accepting new patients
United Memorial Medical Center CurrentSince Aug 18, 2025 Accepting new patients
Mountain Medical of Watertown Physician Assistant Past Accepting new patients

Locations

16 Bank St
Batavia, NY 14020
Phone (585) 344-4800

1001 West St
Carthage, NY 13619
Phone (315) 493-1000

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

1065 Ridge Rd
Webster, NY 14580
Phone (585) 872-2273

Interoperability endpoints

  • Direct secure messaging: laurel.shambo.p2@direct.usppny.nextgenshare.com

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1310601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751932800000",
    "number": "1871881649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KINGS HWY S",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146175504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1065 RIDGE RD",
            "city": "WEBSTER",
            "state": "NY",
            "postal_code": "145802952",
            "telephone_number": "585-872-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9732 State Route 12",
            "address_purpose": "LOCATION",
            "city": "Copenhagen",
            "state": "NY",
            "postal_code": "136262906",
            "country_code": "US",
            "telephone_number": "315-688-2305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAMBO",
        "first_name": "LAUREL",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-14",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "P80534",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03417452",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Webster, NY

Sources for this page

Verify at the official NPI Registry.