Individual provider Active NPI

Shahbanoo Ghaffari Zandi, N.P

  • Adult Health Nurse Practitioner
  • Champlain, NY
National Provider Identifier
1962706804
Registry record updated Dec 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
305524 Issued in NY
Practice address
481 Route 11
Champlain, NY 12919-0000
Phone
(518) 298-2691
Fax
(518) 298-8241
NPI assigned
Jan 7, 2011
Sex
Female
Sole proprietor
No

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 and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in NY, CO
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20110427000845 NY Practitioner - Nurse Practitioner 0446435986 Reassigns benefits to 1 organization
I20220405000879 CO Practitioner - Nurse Practitioner 0446435986 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Richard J D'Amico DO PC Current
since Aug 1, 2017
Accepting new patients
Hudson Headwaters Health Network Past Accepting new patients
Hudson Headwaters Health Network Past Accepting new patients

Locations

74 Margaret St
Plattsburgh, NY 12901
Phone (518) 324-3074

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 305524 NY Primary

Addresses

NPPES NPI Registry

Primary practice location

481 Route 11
Champlain, NY 12919-0000

Mailing address

74 Margaret St
Plattsburgh, NY 12901-2925
Phone (518) 562-2369

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 13, 2016.

{
    "created_epoch": "1294358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481587200000",
    "number": "1962706804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 MARGARET ST",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129012925",
            "telephone_number": "518-562-2369",
            "fax_number": "518-562-2263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "481 ROUTE 11",
            "city": "CHAMPLAIN",
            "state": "NY",
            "postal_code": "129190000",
            "telephone_number": "518-298-2691",
            "fax_number": "518-298-8241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHAFFARI ZANDI",
        "first_name": "SHAHBANOO",
        "credential": "N.P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-07",
        "last_updated": "2016-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "305524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champlain, NY

Sources for this page

Verify at the official NPI Registry.