SHAKER PEDIATRICS PC (NPI# 1336156223) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336156223 |
| Entity Type | Organization |
| Organization Name | SHAKER PEDIATRICS PC |
| Practice Address |
10 Century Hill Drive Latham NY 12110 |
| Practice Telephone | 5187835563 |
| Practice Fax Number | 5187855708 |
| Mailing Telephone | 5187835563 |
| Mailing Fax Number | 5187855708 |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. HENRY M NEILLEY (FIRST VICE PRESIDENT) |
| Authorized Official Telephone | 5187835563 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 02094695 | 05 | |
| MVP DAVID SHERWOOD MD | 349679 | 01 | |
| BS HENRY NEILLEY MD | 000401569001 | 01 | |
| CDPHP GROUP | 1007 | 01 | |
| MVP SHEELA GRANEY MD | 964787 | 01 | |
| BS WILLIAM A PETERSEN MD | 000401387001 | 01 | |
| NY | 01332856 | 05 | |
| CDPHP DAVID SHERWOOD MD | 10044836 | 01 | |
| NY | 00392741 | 05 | |
| BS SHEELA GRANEY MD | 000401340001 | 01 | |
| NY | 01260746 | 05 | |
| CDPHP HENRY NEILLEY MD | 10001463 | 01 | |
| CDPHP WM A PETERSEN MD | 10002804 | 01 | |
| CDPHP SHEELA GRANEY MD | 10021167 | 01 | |
| MVP HENRY NEILLEY MD | 26207 | 01 | |
| MVP WILLIAM A PETERSEN MD | 26208 | 01 | |
| CDPHP MARYLA WARSZAWA-AMB | 10002139 | 01 | |
| MVP MARYLA WARSZAWA-AMB | 26210 | 01 | |
| NY | 00962767 | 05 | |
| NY | 01762674 | 05 |
| Street Address |
10 CENTURY HILL DRIVE |
| City | LATHAM |
| State | NY |
| Zip Code | 12110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154963973 | Bayley Archinal | Physical Therapist | 711 Troy-schenectady Road, Ste 216, Latham, NY 12110 | 2019-10-14 |
| 1114410701 | Kimberly A. Hostig Licensed Clinical Social Worker Pllc | Clinic/Center | 8 Stanley Cir Ste 11, Latham, NY 12110 | 2018-06-08 |
| 1710477260 | Colleen Phillips | Physical Therapist | 711 Troy Schenectady Rd Ste 216, Latham, NY 12110 | 2018-05-10 |
| 1528574779 | Deborah Cannon | Specialist | 33c Waterford Avenue East, Latham, NY 12110 | 2017-12-26 |
| 1730600149 | Michael Navarrete | Dentist | 231 Wade Road Ext Unit 101, Latham, NY 12110 | 2017-07-06 |
| 1316499452 | Colonie Asc LLC | Clinic/Center | 207 Troy-schenectady Rd, Colonie, NY 12110 | 2016-10-25 |
| 1720539950 | Tania M Durante | Pharmacist | 1057 Troy-schenectady Rd, Latham, NY 12110 | 2016-10-24 |
| 1417344987 | New York Epilepsy Medicine, PC | Clinic/Center | 3 Lear Jet Ln Ste 203, Latham, NY 12110 | 2015-04-22 |
| 1346664752 | Lauren Gannon | Registered Nurse | 95 Forts Ferry Road, Latham, NY 12110 | 2014-02-06 |
| 1649522756 | Natasha Kapsaroff-ruiz | Nurse Practitioner | 654 Watervliet Shaker Rd, Latham, NY 12110 | 2012-10-12 |
| Find all providers in zip 12110 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699880864 | Henry M. Neilley | Pediatrics | 10 Century Hill Dr, Latham, NY 12110-2162 | 2006-08-20 |
| 1144335324 | Maryla Warszawa-ambros | Pediatrics | 10 Century Hill Dr, Latham, NY 12110-2162 | 2006-08-20 |
| 1881709079 | William A Petersen | Pediatrics | 10 Century Hill Dr, Latham, NY 12110-2162 | 2006-08-20 |
| 1114032125 | Sheela S Graney | Pediatrics | 10 Century Hill Dr, Latham, NY 12110-2162 | 2006-08-20 |
| 1427163435 | David E Sherwood | Pediatrics | 10 Century Hill Dr, Latham, NY 12110-2162 | 2006-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902438039 | Joanna Catherine Cross | Pediatrics | 6049 Transit Rd Ste 101, East Amherst, NY 14051-1803 | 2020-02-06 |
| 1720498306 | Ashley M Yazdani | Pediatrics | 3950 East Robinson Road, Suite 205, West Amherst, NY 14228 | 2014-05-05 |
| 1699103879 | Pediatric&adolescent Medical Care Pllc | Pediatrics | 450 76th St, Brooklyn, NY 11209-3204 | 2013-10-24 |
| 1962837377 | Mariam Machabeli | Pediatrics | 765 Grand St, Brooklyn, NY 11211-5797 | 2013-09-05 |
| 1013352392 | Pediatric Associates of Plainview | Pediatrics | 400 S Oyster Bay Rd Ste 207, Hicksville, NY 11801-3500 | 2013-05-01 |
| 1174876650 | Theodore Fink | Pediatrics | 1 Rudolph Dr, Apt. 1s, Carle Place, NY 11514-1095 | 2012-10-20 |
| 1376804096 | Melissa Ellen Dere | Pediatrics | 732 5th Ave, Brooklyn, NY 11232 | 2012-05-30 |
| 1386915544 | Marvin Lieber | Pediatrics | 58 Sycamore Cir, Stony Brook, NY 11790-3147 | 2012-01-19 |
| 1508134578 | Hicksville Pediatrics PC | Pediatrics | 535 S Broadway, Suite 1, Hicksville, NY 11801-5029 | 2011-12-06 |
| 1245523513 | Khalida Itriyeva | Pediatrics | 410 Lakeville Rd Ste 108, New Hyde Park, NY 11042 | 2011-05-19 |
| Find all providers with the same taxonomy | ||||
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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.