SHANNON M ROACH (NPI# 1225514623) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225514623 |
| Entity Type | Individual |
| Full Name | SHANNON M ROACH |
| Credential | NP |
| Practice Address |
5100 W Taft Rd Liverpool NY 13088-3807 |
| Mailing Address |
2567 E Mechanic St Cato NY 13033-3411 |
| Practice Telephone | 3154522828 |
| Mailing Telephone | 3157290951 |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2018-07-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
402481 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5100 W TAFT RD |
| City | LIVERPOOL |
| State | NY |
| Zip Code | 13088-3807 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023015500 | Jody S Bleier | Internal Medicine | 5100 W Taft Rd, Suite 4j, Liverpool, NY 13088-3807 | 2005-06-30 |
| 1528620812 | Colleen Byrnes | Nurse Practitioner | 5100 W Taft Rd, Liverpool, NY 13088-3807 | 2019-07-08 |
| 1851866727 | Kathryn Quinn Manion | Clinic/Center | 5100 W Taft Rd, Liverpool, NY 13088-3807 | 2018-10-08 |
| 1497263826 | Kimberly Cleary | Registered Nurse | 5100 W Taft Rd, Liverpool, NY 13088-3807 | 2018-01-19 |
| 1184077885 | Maia Czarnecki | Physician Assistant | 5100 W Taft Rd, Suite 1c, Liverpool, NY 13088-3807 | 2016-07-18 |
| 1174974216 | Jenna Marie Laskey | Family Medicine | 5100 W Taft Rd, Liverpool, NY 13088-3807 | 2016-06-30 |
| 1669838108 | Phitsamai Thatvihane | Nurse Practitioner | 5100 W Taft Rd, Suite 1c, Liverpool, NY 13088-3807 | 2016-01-14 |
| 1992160188 | Melissa Buttner | Physician Assistant | 5100 W Taft Rd, Suite 1c, Liverpool, NY 13088-3807 | 2015-12-15 |
| 1538532940 | Chelsey Brooks | Physician Assistant | 5100 W Taft Rd, Suite 1c, Liverpool, NY 13088-3807 | 2015-11-06 |
| 1477960474 | Lisa J. Isabell | Nurse Practitioner | 5100 W Taft Rd, Liverpool, NY 13088-3807 | 2014-07-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245878966 | Anthony Edward Blumetti | Psychologist | 5100 W. Taft Road, Suite 3b, Liverpool, NY 13088 | 2019-12-12 |
| 1609350016 | Alice Nellenbach | Physical Therapy Assistant | 346 Electronics Pkwy, Liverpool, NY 13088 | 2018-09-20 |
| 1043741457 | Dawn Marie Thomas | Licensed Practical Nurse | 212 Old Liverpool Road, Building 7 Apartment 6, Liverpool, NY 13088 | 2017-03-27 |
| 1154775633 | Arielle L Leonard | Massage Therapist | 609 7th N. Street, Suite 2, Liverpool, NY 13088 | 2016-04-20 |
| 1942664362 | Accessibility Solutions, Inc. | Contractor | 115 Luther Avenue, Liverpool, NY 13088 | 2016-04-12 |
| 1497176333 | Sergey Golovko | Psychiatry & Neurology | 125 Sun Harbor Dr, Liverpool, NY 13088 | 2013-12-19 |
| 1205275286 | Brandon William Crandall | Nurse Practitioner | 5100 West Taft Rd., Suite 1c, Liverpool, NY 13088 | 2013-06-23 |
| 1184976805 | Audrey Irene Tyszka | Social Worker | 5100 W Taft Rd Ste 1f, Liverpool, NY 13088 | 2012-10-04 |
| 1790049096 | Kelley Beth Burt | Speech-Language Pathologist | 110 Elwood Davis Road, Liverpool, NY 13088 | 2012-07-02 |
| 1811288954 | Nedim Ruhotina | Urology | 100 Metropolitan Park Drive, Suite 100, Liverpool, NY 13088 | 2011-04-24 |
| Find all providers in zip 13088 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487807582 | Tania Urszula Marschall | Nurse Practitioner | 7754 Deerfield Rd, Liverpool, NY 13090-2308 | 2008-11-03 |
| 1316302409 | Kristen Milburn | Nurse Practitioner | 600 Oswego St, Suite 1, Liverpool, NY 13088-5178 | 2015-12-16 |
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|---|---|---|---|---|
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| 1619578366 | Jecinter L Otieno | Nurse Practitioner | 195 Hillside Dr, Oneonta, NY 13820-3611 | 2020-11-07 |
| 1073113833 | Natalie Grant-villegas | Nurse Practitioner | 1210 Fulton St Apt 1, Brooklyn, NY 11216-2003 | 2020-10-29 |
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| 1407455967 | Marie J. Schwarz, Npp-bc PC | Nurse Practitioner | 133 E Main St Ste 3h, Babylon, NY 11702-3517 | 2020-10-25 |
| 1720687015 | Ashley Winn | Nurse Practitioner | 367 E Chester St, Long Beach, NY 11561-2324 | 2020-10-19 |
| 1114525961 | Tanya Monique Sydnor Holmes | Nurse Practitioner | 1601 Baldwin Blvd, Bay Shore, NY 11706-2145 | 2020-10-14 |
| 1669079976 | Mary Lynn Good | Nurse Practitioner | 3344 Chambers Rd # 200, Horseheads, NY 14845-1403 | 2020-10-08 |
| 1376140277 | Megan Elizabeth Bhatti | Nurse Practitioner | 2104 Delaware Ave Apt 1, Buffalo, NY 14216-3216 | 2020-10-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.