Individual provider Active NPI

Sarah Lynn Shadallah, ARNP

  • Family Nurse Practitioner
  • Plymouth, NH
National Provider Identifier
1902142367
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
060508-23 Issued in NH
Practice address
1 Warren St
Plymouth, NH 03264-1416
Phone
(603) 238-3149
Fax
(603) 238-9239
NPI assigned
Dec 12, 2012
Last updated
Oct 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 060508-23 NH Primary

Addresses

Primary practice location

1 Warren St
Plymouth, NH 03264-1416

Mailing address

1 Warren St
Plymouth, NH 03264-1416
Phone (603) 238-3149

Other identifiers 1

IdentifierTypeStateIssuer
3091511MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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
I20130207000012 NH Practitioner - Nurse Practitioner 9436303013 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Joseph Hospital of Nashua NH CurrentSince Apr 21, 2018 Accepting new patients
St Joseph Hospital of Nashua NH CurrentSince Apr 21, 2018 Accepting new patients
Greater Hampstead Family Medicine, Inc. CurrentSince Feb 1, 2023 Accepting new patients
Steward Medical Group Inc. Past Accepting new patients

Locations

208 Robinson Rd
Hudson, NH 03051
Phone (603) 577-3410

55 Bridge St
Manchester, NH 03101

172 Kinsley St
Nashua, NH 03060
Phone (603) 595-3926

173 Daniel Webster Hwy
Nashua, NH 03060
Phone (603) 891-4400

159 N Broadway
Salem, NH 03079
Phone (603) 893-4119

Organizations & group practices 5

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": "1355270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1902142367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WARREN ST",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "032641416",
            "telephone_number": "603-238-3149",
            "fax_number": "603-238-9239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WARREN ST",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "032641416",
            "telephone_number": "603-238-3149",
            "fax_number": "603-238-9239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADALLAH",
        "first_name": "SARAH",
        "middle_name": "LYNN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-12",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NH",
            "license": "060508-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3091511",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, NH

Sources for this page

Verify at the official NPI Registry.