Lacey E Shambo, DNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

350243 Issued in NY

Practice address

18983 US Route 11
Watertown, NY 13601-5320

Phone

(315) 782-0059

NPI assigned

Jun 20, 2022

Last updated

Mar 26, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 8

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, CO, TX3 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 3

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Karen a. Williams MD PCGroup PAC ID 4789620238, 4 clinicians

Jonathan Larson MD PCGroup PAC ID 8224491501, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Co Pub HLTH SVS Chha Home health agency, Watertown, NY, CCN 337056
• Samaritan Medical Center Hospital, Watertown, NY, CCN 330157
• Gouverneur Hospital Hospital, Gouverneur, NY, CCN 331315

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lshambo@completefamilycare.medentdirect.com

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.

• Karen a. Williams, MD, PC

  dba Complete Family Care & Laser Center

  • Family Medicine Physician
  • Watertown, NY
  • NPI 1992898191
  Medicare reassignment Care Compare group NPD
• Jonathan Larson MD PC

  • Adult Health Nurse Practitioner
  • Columbus, OH
  • NPI 1487334843

  CO, TX

  Medicare reassignment Care Compare group NPD
• Midtown East Medical Services, PC

  • Nurse Practitioner
  • Pittsford, NY
  • NPI 1801292800
  Medicare reassignment
• Central Texas Holistic Care PLLC

  • Family Nurse Practitioner
  • Killeen, TX
  • NPI 1568295616
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Gouverneur Hospital

  • Critical Access Hospital
  • Gouverneur, NY
  • NPI 1629409925
  Care Compare affiliation
• Jefferson County Public Health Service

  • Home Health Agency
  • Watertown, NY
  • NPI 1043213283
  Care Compare affiliation
• Samaritan Medical Center

  • General Acute Care Hospital
  • Watertown, NY
  • NPI 1598713745
  Care Compare affiliation

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

{
    "created_epoch": "1655683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1902537038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15895 HAMP RD",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136016768",
            "telephone_number": "315-523-1499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18983 US ROUTE 11",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136015320",
            "telephone_number": "315-782-0059"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 N Litchfield Rd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Goodyear",
            "state": "AZ",
            "postal_code": "853957802",
            "country_code": "US",
            "telephone_number": "949-484-9517",
            "fax_number": "949-569-1295",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2025 Memory Ln Ste 300",
            "address_purpose": "LOCATION",
            "city": "Harker Heights",
            "state": "TX",
            "postal_code": "765487488",
            "country_code": "US",
            "telephone_number": "949-484-9517",
            "fax_number": "949-569-1295",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "122 Delaware Street SteF-5",
            "address_purpose": "LOCATION",
            "city": "New Castle",
            "state": "DE",
            "postal_code": "197204814",
            "country_code": "US",
            "telephone_number": "949-484-9517",
            "fax_number": "949-569-1295",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7261 S Broadway Ste 14L",
            "address_purpose": "LOCATION",
            "city": "Littleton",
            "state": "CO",
            "postal_code": "801228019",
            "country_code": "US",
            "telephone_number": "949-484-9517",
            "fax_number": "949-569-1295",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5 Greentree Center",
            "address_2": "Suite 117",
            "address_purpose": "LOCATION",
            "city": "Marlton",
            "state": "NJ",
            "postal_code": "08053",
            "country_code": "US",
            "telephone_number": "949-484-9517",
            "fax_number": "949-569-1295",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3499 Blazer Pkwy Ste 325",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405092798",
            "country_code": "US",
            "telephone_number": "949-484-9517",
            "fax_number": "949-569-1295",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "635 Main St Ste 206A",
            "address_purpose": "LOCATION",
            "city": "Klamath Falls",
            "state": "OR",
            "postal_code": "976016007",
            "country_code": "US",
            "telephone_number": "949-484-9517",
            "fax_number": "949-569-1295",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAMBO",
        "first_name": "LACEY",
        "middle_name": "E",
        "credential": "DNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-20",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "TPAN2536",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1169690",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "DE",
            "license": "LG-0012858",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "350243",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.1000145-NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "10042097",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "4036258",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "689095",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tabatha M Sellick, SW
• Mariana Olga Serback, MS, RDN
• Bonnie L Servage, ANP
• Raven-Jade Harlequinn Shaddows
• Kylie Shafer, PT, DPT, PCS
• Mark Patrick Sharrow
• Heather Mary Shattuck, PTMS
• Brooke Laforty Shaw, CCC-SLP
• Jana Shaw, MD
• Beverly Shepard, N.P.

• Family Nurse Practitioner in Watertown, NY
• Providers in Watertown, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.